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Long-term survival of concurrent meniscus allograft transplantation and repair of the articular cartilage: a prospective two- to 12-year follow-up report
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AMP (Acute Meniscal Pathology)
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We describe 119 meniscal allograft transplantations performed concurrently with articular cartilage repair in 115 patients with severe articular cartilage damage. In all, 53 (46.1%) of the patients were over the age of 50 at the time of surgery. The mean follow-up was for 5.8 years (2 months to 12.3 years), with 25 procedures (20.1%) failing at a mean of 4.6 years (2 months to 10.4 years). Of these, 18 progressed to knee replacement at a mean of 5.1 years (1.3 to 10.4). The Kaplan-Meier estimated mean survival time for the whole series was 9.9 years (sd 0.4). Cox's proportional hazards model was used to assess the effect of covariates on survival, with age at the time of surgery (p = 0.026) and number of previous operations (p = 0.006) found to be significant. The survival of the transplant was not affected by gender, the severity of cartilage damage, axial alignment, the degree of narrowing of the joint space or medial versus lateral allograft transplantation. Patients experienced significant improvements at all periods of follow-up in subjective outcome measures of pain, activity and function (all p-values < 0.05), with the exception of the seven-year Tegner index score (p = 0.076).
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Prevalence of insomnia and associated factors in a community sample of elderly individuals in South Korea
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DoD PRF (Psychosocial RF)
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Background: Insomnia is a common psychiatric complaint among elderly individuals. This study investigates the prevalence and sociodemographic correlates of insomnia by considering a community sample of elderly individuals in South Korea. Methods: A face-to-face household survey was conducted in five regions of South Korea from June 2008 to August 2008. Among a total of 3,074 individuals aged 65 years and over, 2,002 participants were interviewed. The presence of insomnia was defined as having at least one of four sleep complaints that included difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), early morning awakening (EMA), and non-restorative sleep (NRS) more than three times per week in the last month. The Restless Legs Syndrome (RLS) Questionnaire, a short form of the Geriatric Depression scale (GDS), and a medical review of systems were implemented. Results: Insomnia was found in 29.2% of the participants. DIS, DMS, EMA, and NRS accounted for 19.4%, 21.7%, 19.6%, and 8.0% of the participants respectively. Insomnia accompanied by daytime consequences accounted for 17.1% of the participants. The participants who were females, had no education, lived alone, showed symptoms of RLS or depression, and had a lifetime history of physical illness were significantly more likely to report insomnia. The prevalence of DIS, DMS, EMA, or insomnia increased slightly with age, whereas that of NRS decreased slightly. The lifetime history of head trauma, hyperlipidemia, heart disease, anemia, or depression was significantly related to insomnia. Conclusion: Sleep problems are common among elderly individuals and are closely related to their lifetime history of physical illness. Copyright © International Psychogeriatric Association 2013.
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Changes in the Welfare of an Injured Working Farm Dog Assessed Using the Five Domains Model
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DoD LSA (Limb Salvage vs Amputation)
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The present structured, systematic and comprehensive welfare evaluation of an injured working farm dog using the Five Domains Model is of interest in its own right. It is also an example for others wanting to apply the Model to welfare evaluations in different species and contexts. Six stages of a fictitious scenario involving the dog are considered: (1) its on-farm circumstances before one hind leg is injured; (2) its entanglement in barbed wire, cutting it free and transporting it to a veterinary clinic; (3) the initial veterinary examination and overnight stay; (4) amputation of the limb and immediate post-operative recovery; (5) its first four weeks after rehoming to a lifestyle block; and (6) its subsequent life as an amputee and pet. Not all features of the scenario represent average-to-good practice; indeed, some have been selected to indicate poor practice. It is shown how the Model can draw attention to areas of animal welfare concern and, importantly, to how welfare enhancement may be impeded or facilitated. Also illustrated is how the welfare implications of a sequence of events can be traced and evaluated, and, in relation to specific situations, how the degrees of welfare compromise and enhancement may be graded. In addition, the choice of a companion animal, contrasting its welfare status as a working dog and pet, and considering its treatment in a veterinary clinical setting, help to highlight various welfare impacts of some practices. By focussing attention on welfare problems, the Model can guide the implementation of remedies, including ways of promoting positive welfare states. Finally, wider applications of the Five Domains Model are noted: by enabling both negative and positive welfare-relevant experiences to be graded, the Model can be applied to quality of life assessments and end-of-life decisions and, with particular regard to negative experiences, the Model can also help to strengthen expert witness testimony during prosecutions for serious ill treatment of animals.
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Nationwide diabetes-related lower extremity amputation rates in secondary care treated patients with diabetes in the Netherlands (DUDE-7)
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DoD LSA (Limb Salvage vs Amputation)
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AIMS: To estimate the annual amputation rate in all secondary care treated patients with diabetes in the Netherlands and specifically in patients known with diabetic retinopathy. METHODS: A nationwide population-based retrospective cohort study was performed including the years 2007-2011. Data of patients were retrieved from reimbursement registries for hospital care from a nationwide insurance database including codes for diabetes, retinopathy and amputation. Traumatic amputations were excluded. RESULTS: The number of patients with secondary care treated diabetes increased from 132.499 to 137.049 over the years 2007-2011 in the Netherlands. The annual rate of non-traumatic lower-extremity amputations ranged from 4.32 to 5.28 amputations per 1.000 patients. For patients diagnosed with non-proliferative and (pre-) proliferative diabetic retinopathy, the mean amputation rates were 7.9 per 1.000 and 14.7 per 1.000, respectively. CONCLUSION: The Dutch annual incidence rates of non-traumatic lower extremity amputations in secondary care treated patients with diabetes is relatively low and remained stable over the years 2007 to 2011. The amputation rate in patients with retinopathy was substantially higher compared to patients without retinopathy.
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Using health-related quality of life assessments to evaluate care support within Medicaid
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Management of Hip Fractures in the Elderly
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CareOregon, an Oregon-based not-for-profit Medicaid health plan, successfully piloted a "CareSupport" model that identifies high-risk members and clinically stratifies them for intervention. Internal analyses indicate that CareSupport lowers utilization and cost; CareOregon, however, has lacked patient-reported outcome data on the health-related quality of life (HRQL) of CareSupport participants. Between September 2005 and November 2006, we conducted a pilot study in which the Health Utilities Index Mark 3 (HUI3), a generic preference-based measure of health status and HRQL, was integrated into CareOregon's existing screening algorithm for possible admission into CareSupport. We obtained baseline data on 616 CareSupport candidates and 4-month HUI3 follow-up data on 143 candidates (104 CareSupport 39 non-CareSupport). On a 0.00 (dead)-to-1.00 (perfect health) scale, the mean overall baseline HUI3 score for CareSupport patients was 0.18 (0.20 for non-CareSupport patients), comparable to baseline means reported elsewhere for much older patients immediately after suffering serious acute medical events, such as stroke or hip fracture. A 0.05 mean 4-month improvement in overall HRQL among CareSupport enrollees relative to non-CareSupport enrollees was clinically important but not statistically significant. A 0.10 improvement in HUI3 emotion was both statistically significant and clinically important. Study results provide good preliminary evidence of the value of patient-reported outcomes in clarifying individual illness burden and assessing intervention effectiveness
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Results of non-operative treatment following hip fracture compared to surgical intervention
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Management of Hip Fractures in the Elderly
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We followed all consecutive hip fracture patients admitted between 2004 and 2006, identified cases in which the intention was to treat non-operative and compared their functional outcome and mortality with a similar cohort treated surgically over the same period. We recorded length of hospital stay, place of discharge, pre and post-fracture mobility and residence, 30 days and 1 year mortality, re-admission due to same fracture and delayed surgery. The group treated surgically was recruited and matched for age, gender, pre and post-fracture mobility, mental confusion and independence. 25 patients were treated non-operative. 22 patients treated surgically over the same time period matched the patient characteristics of the non-operative arm. The mean hospital stay was 13 days in both groups. There were 4 extra-capsular fractures (3 displaced) and 21 intra-capsular fractures (5 displaced) in the non-operative arm and 11 extra-capsular fractures and 9 intra-capsular fractures in the surgically treated arm. 4 patients from the non-operative treatment group underwent late surgery because of persisting hip pain 20 days-2 months after the index event (2 cannulated screws, 1 hemiarthroplasty, 1 total hip arthroplasty). 11 patients in the surgical treatment arm underwent dynamic screw fixation, 1 had cannulated screw, 1 had total hip replacement and 7 had hemiarthroplasty. 14 of the non-operative treated patients were mobile independently or with aid before fracture but only 9 patients retained their pre-fracture mobility following treatment, compared to 16 patients pre-fracture and 11 patients post-fracture after surgery. 16 patients treated non-operative were living independently prior to injury but only 7 went back to their own residence. Of the operatively treated patients 14 patients were living independently and 10 patients went back to their previous residence. 1 month and 1 year mortality in the non-operative treated group was 4/21 and 7/21 respectively compared to 1/20 and 5/20 in the operative fixation group. There was no statistically significant difference in mobility, residence or mortality between the two groups (Fisher exact test, p>0.05). Non-operative management after hip fracture is suitable for medically unfit patients and does not result in statistically significant difference in functional outcome or mortality compared to patients treated surgically
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Surgery for the arthritic hip and knee
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Surgical Management of Osteoarthritis of the Knee CPG
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Pain is the principal reason for which patients seek operation on arthritic joints. Currently, surgery for the painful hip is dominated by total hip replacement. Unless unforeseen late complications develop, this situation is likely to continue. For the knee a much greater range of procedures is currently in use. Even so, they do not cover all the variations of the arthritic knee. The newer total knee replacements seem likely to expand the range of useful procedures. The requirements and motivation of the individual patient must be carefully evaluated in planning the timing and type of knee surgery
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Primary carcinoma of the Bartholin gland: a report of 14 cases and review of the literature
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MSTS 2018 - Femur Mets and MM
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Fourteen cases of primary carcinoma of the Bartholin gland were treated between 1955 and 1980. Follow-up information was available on all patients. Ten patients have survived free of disease for 5 or more years. Three patients with positive inguinal lymph nodes have survived 5 years. Histological patterns and lymph node involvement are analyzed. The authors' data and a review of the literature support the concept that radical vulvectomy with bilateral inguinal-femoral lymphadenectomy is required for all histologic types of Bartholin gland carcinoma. Routine pelvic lymph node dissection is not necessary when the inguinal-femoral nodes are negative for metastases.
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Two cases of septic arthritis by Mycoplasma hominis after total knee replacement arthroplasty
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Surgical Management of Osteoarthritis of the Knee CPG
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Mycoplasma hominis has been related with pelvic inflammatory illnesses and postpartum and neonatal infections. Extragenital M. hominis infections are rare, but septicemia, septic arthritis, wound infection, meningitis, and other infections in Immunocompromised patients have also been described. Here we report two cases of septic arthritis caused by M. hominis in patients following total knee replacement arthroplasty. After the surgery, the patients presented with knee pain and clinical signs of infection, such as fever, erythema and swelling on the surgical site. Arthroscopic debridement operations were performed on the surgical site. M. hominis was isolated from the joint fluid and identified by the microscopic visualization of the typical "fried-egg-type" colonies on Mycoplasma specific agar (pleuropneumonia-like organism agar). It was also confirmed by 16S rRNA sequencing. To the best of our knowledge, this is the first report of prosthetic joint infections with M. hominis in Korea
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Total ankle arthroplasty: What are the risks?: A guide to surgical consent and a review of the literature
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DoD LSA (Limb Salvage vs Amputation)
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Aims Total ankle arthroplasty (TAA) surgery is complex and attracts a wide variety of complications. The literature lacks consistency in reporting adverse events and complications. The aim of this article is to provide a comprehensive analysis of each of these complications from a literature review, and to compare them with rates from our Unit, to aid clinicians with the process of informed consent. Patients and Methods A total of 278 consecutive total ankle arthroplasties (251 patients), performed by four surgeons over a six-year period in Wrightington Hospital (Wigan, United Kingdom) were prospectively reviewed. There were 143 men and 108 women with a mean age of 64 years (41 to 86). The data were recorded on each follow-up visit. Any complications either during initial hospital stay or subsequently reported on follow-ups were recorded, investigated, monitored, and treated as warranted. Literature search included the studies reporting the outcomes and complications of TAA implants. Results There were wound-healing problems in nine ankles (3.2%), superficial infection in 20 ankles (7.2%), and deep infection in six ankles (2.2%). Intraoperative fractures occurred in medial malleoli in 27 ankles (9.7%) and in lateral malleoli in four ankles (1.4%). Aseptic loosening and osteolysis were seen 16 ankles (5.8%). Fracture of the polyethylene component occurred in one ankle (0.4%) and edge-loading in seven ankles (2.5%). We observed medial gutter pain in 31 ankles (11.1%). The incidence of thromboembolism occurred in two ankles (0.7%). The results were found to be comparable to the previously reported complications of total ankle arthroplasty in the literature. Conclusion Total ankle arthroplasty continues to evolve and improve the ankle function. Despite high overall complication rates with TAA surgery, most complications appear to be minor and do not affect final clinical outcome. Our results and literature review will help in the consent process and provide detailed complication rates for an informed consent.
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Pseudoarthrosis of the ilium after periacetabular osteotomy that was treated by cemented total hip arthroplasty: A case report
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PJI DX Updated Search
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Background: Preserving the hip joint to delay arthroplasty for patients with acetabular dysplasia-associated early-stage osteoarthritis has become more common, and several surgical procedures have demonstrated pain relief and improved hip joint function. Periacetabular osteotomy, one of the joint-preserving surgical procedures of the hip, provides favorable outcomes, although there are no reports of total hip arthroplasty being used to treat pseudoarthrosis of the periacetabular osteotomy segment. Therefore, we report a case of pseudoarthrosis in the osteotomy segment after periacetabular osteotomy. The patient was treated using modified total hip arthroplasty and achieved a favorable short-term outcome. Case presentation: A 62-year-old Japanese woman was diagnosed with bilateral acetabular dysplasia at the age of 50 years, and underwent right and left periacetabular osteotomy at the ages of 52 and 55 years, respectively. When she was 61-years old, she experienced repeated episodes of left coxalgia during walking, with increasing pain at rest, and subsequently visited our department. Plain radiography and computed tomography of her left hip joint confirmed pseudoarthrosis of the periacetabular osteotomy segment. In addition, narrowing of her left hip joint space was observed, which indicated advanced osteoarthritis of the hip. Therefore, she underwent left total hip arthroplasty when she was 62-years old. During the surgery, fibrous fusion of the periacetabular osteotomy segment was confirmed via fluoroscopy, although no abnormal mobility was observed. Thus, the osteotomy segment was fixed with one absorbable screw and two bone pegs (which were prepared using allogeneic bone), and the acetabular cup was fixed using cement. Her postoperative course was generally favorable and bone fusion of the periacetabular osteotomy segment was confirmed at 3 years and 6 months after surgery. Her modified Harris hip score was 43 before the surgery and had improved to 90 at the final follow-up. Conclusions: Modified total hip arthroplasty was successfully used to treat osteoarthritis of the hip and pseudoarthrosis of the periacetabular osteotomy segment. This procedure achieved pseudoarthrosis region bone fusion and a favorable postoperative outcome
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The Danish Registry for Plastic Surgery of the Breast: establishment of a nationwide registry for prospective follow-up, quality assessment, and investigation of breast surgery
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Reduction Mammoplasty for Female Breast Hypertrophy
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Although numerous epidemiologic studies have examined the long-term safety of silicone breast implants during the past decade, there is a relative lack of surveillance data on short-term health effects and complications following cosmetic surgery of the breast. The Danish Registry for Plastic Surgery of the Breast, established in May of 1999, provides plastic surgeons with a nationwide system for the collection of preoperative, perioperative, and postoperative data on women undergoing breast implantation, breast reduction, or mastopexy. The purpose of the Registry is to examine short-term and, eventually, long-term local complications and possible health effects, and to contribute to an ongoing evaluation of surgical results and surveillance of the products. Furthermore, the Registry will allow the identification of new areas for research into cosmetic and reconstructive breast surgery. Women accepting registration in the Danish Registry for Plastic Surgery of the Breast complete a self-administered questionnaire focusing on medical history and demographic and behavioral factors. Preoperative blood samples are drawn for storage. Surgical data, postoperative results, and complications are registered following surgery and at postoperative visits. Currently, registration has been initiated at 24 private and public clinics, representing more than 80 percent of the plastic surgery clinics in Denmark. As of November of 2001, a total of 1472 women with breast implants and 560 women with breast reduction were included in the Registry. These figures are expected to increase annually by 1000 women undergoing breast implantation and 500 women undergoing breast reduction or mastopexy. The authors present their experience of establishing the first nationwide comprehensive clinical-epidemiologic database and biological bank for cosmetic and reconstructive surgery procedures.
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The role of arthroscopy in trapeziometacarpal arthritis
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SR for PM on OA of All Extremities
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BACKGROUND: Trapeziometacarpal (TM) arthroscopy should be viewed as a useful minimally invasive adjunctive technique rather than the operation itself since it allows one to visualize the joint surface under high-power magnification with minimal disruption of the important ligamentous complex. Relatively few articles describe the arthroscopic treatment of TM osteoarthritis (OA) and the arthroscopic anatomy of the TM joint. There is lingering confusion as to whether soft tissue interposition and K-wire fixation of the joint are needed and whether the outcomes of arthroscopic procedures compare to the more standard open techniques for TM arthroplasty. QUESTIONS/PURPOSES: This paper describes (1) the arthroscopic ligamentous anatomy of the TM joint, (2) the portal anatomy and methodology behind TM arthroscopy, and (3) the arthroscopic treatment for TM OA, including the current clinical indications for TM arthroscopy and the expected outcomes from the literature. METHODS: A MEDLINE((R)) search was used to retrieve papers using the search terms trapeziometacarpal, carpometacarpal, portal anatomy, arthroscopy portals, arthroscopy, arthroscopic, resection arthroplasty, and arthroscopic resection arthroplasty. Eighteen citations satisfied the search terms and were summarized. RESULTS: Careful wound spread technique is needed to prevent iatrogenic injury to the surrounding superficial radial nerve branches. Traction is essential to prevent chondral injury. Fluoroscopy should be used to help locate portals as necessary. Cadaver training is desirable before embarking on a clinical case. Questions regarding the use of temporary K-wire fixation or thermal shrinkage or the need for a natural or synthetic interposition substance cannot be answered at this time. CONCLUSIONS: Longitudinal prospective studies are needed to answer these lingering questions. An intimate knowledge of the portal and arthroscopic anatomy is needed to perform TM arthroscopy. Minimally invasive techniques for resection arthroplasty in TM OA with and without soft tissue interposition can yield good outcomes in the treatment of TM OA
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Force required for wound closure and scar appearance
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Reduction Mammoplasty for Female Breast Hypertrophy
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I am reporting the first objective documentation of the correlation between the force required for wound-edge approximation (closure) and eventual scar width. Seven patients undergoing reduction mammaplasty were studied, and 234 measurements of force required for wound-edge approximation were made. At follow-up 1 year after surgery, the scar width was measured and the appearance was noted and photographed. A significant correlation was demonstrated between the force required for wound-edge approximation and scar width at every location but one. In addition, the scars were significantly wider near the midline of the breast than at the ends of the reduction mammaplasty incision. Neither color match (to surrounding skin) nor scar elevation (hypertrophy) were related to the force required for wound-edge approximation.
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DNA damage in breast epithelial cells: detection by the single-cell gel (comet) assay and induction by human mammary lipid extracts
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Reduction Mammoplasty for Female Breast Hypertrophy
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The presence of DNA damage in primary cultures of human mammary epithelial cells (HMECs), and the ability of extracts of human mammary lipid to cause such damage, has been investigated. Lipid extracts, prepared by a solid-phase procedure, and HMECs were obtained from breast tissue removed from healthy women (ages 18-50 years) who were resident in the UK and undergoing elective reduction mammoplasties. DNA single strand breaks (SSBs) were detected using the single-cell gel assay (comet assay) with alkaline electrophoresis (pH 12.3) and quantified by measuring comet tail length (CTL) (microm). Untreated HMECs and HMECs incubated (30 min, 37 degrees C) with a mammary lipid extract, with or without DNA-repair inhibitors hydroxyurea (HU) and cytosine arabinoside (ara-C), were examined. Ionizing radiation was used as a positive control. An active lipid extract gave a linear dose-response over the range 2.0-12.2 g equivalents. When MCL-5 cells, a line of metabolically-competent human lymphoblastoid cells, were used to compare the DNA-damaging properties of lipid extracts from six different donors, significant interindividual variations (median CTLs were 15.0, 53.5, 32.5, <4.0, <4.0 and 77.5 microm respectively) were observed. In eight subjects, the donors' HMECs were examined both before and after treatment with extracts of that donor's own lipid. Pre-existing DNA damage was detected in untreated HMECs from some donors (median CTLs 22.0-37.5 microm) that was not present in others (median CTLs 4.0-11.5 microm), and increases in CTL could be induced by incubation with the matching lipid extract (8 g equivalent) in more than half (five out of eight) the subjects examined (median CTL up to 111.0 microm). There was a tendency for the most active lipid extracts to be those obtained from donors whose HMECs also contained the most pre-existing DNA SSBs. The results of this pilot study may prove to be significant in relation to the initiation of breast cancer.
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Entrapment of the long head of the biceps tendon: the hourglass biceps--a cause of pain and locking of the shoulder
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AMP (Acute Meniscal Pathology)
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We describe an unrecognized mechanical condition affecting the long head of the biceps (LHB) tendon with entrapment of the tendon within the joint and subsequent pain and locking of the shoulder on elevation of the arm. We identified 21 patients with a hypertrophic intraarticular portion of the LHB tendon during open surgery (14 patients) or arthroscopic surgery (7 patients). All cases but one were associated with a rotator cuff rupture. Patients were treated by biceps tenotomy (2 patients) or tenodesis (19 patients) after removal of the hypertrophic intraarticular portion of the tendon and appropriate treatment of concomitant lesions. Minimum follow-up was 1 year. All patients presented with anterior shoulder pain and loss of active and passive elevation averaging 10 degrees to 20 degrees. A dynamic intraoperative test, involving forward elevation with the elbow extended, demonstrated entrapment of the tendon within the joint in each case. This test creates a characteristic buckling of the tendon and squeezing of it between the humeral head and the glenoid (hourglass test). The mean Constant score improved from 38 to 76 points at the final follow-up (P <.05). Complete and symmetric elevation was restored in all cases after resection of the intraarticular portion of the LHB tendon. The hourglass biceps is caused by a hypertrophic intraarticular portion of the tendon that is unable to slide into the bicipital groove during elevation of the arm; it can be compared with the condition of trigger finger in the hand. A loss of 10 degrees to 20 degrees of passive elevation, bicipital groove tenderness, and radiographic findings of a hypertrophied tendon can aid in the diagnosis. A definitive diagnosis is made at surgery with the hourglass test: incarceration and squeezing of the tendon within the joint during forward elevation of the arm with the elbow extended. The hourglass biceps is responsible for a mechanical block, which is similar to a locked knee with a bucket-handle meniscal tear. Simple tenotomy cannot resolve this mechanical block. Excision of the intraarticular portion of the LHB tendon, during bipolar biceps tenotomy or tenodesis, must be performed. The hourglass biceps is an addition to the familiar pathologies of the LHB (tenosynovitis, prerupture, rupture, and instability) and should be considered in cases of shoulder pain associated with a loss of elevation.
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Partial denervation for persistent neuroma pain after total knee arthroplasty
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AAHKS (9/10) Regional Nerve Blocks
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Despite the high percentage of patients who are satisfied completely with the results of total knee arthroplasty, there is a small group who remain disabled because of persistent neuroma pain. Recently, a better understanding of the innervation of the skin and capsule around the human knee joint has provided a theoretical basis for denervation in this group of patients. Fifteen patients were identified who had persistent or worse knee pain for > 6 months after total knee arthroplasty. In each patient, component loosening, malalignment, knee instability, and infection had been excluded systematically as a source of pain. Pain was evaluated preoperatively with the Knee Society Functional Score Questionnaire and a visual analog scale. To be selected for surgery, each patient must have had a reduction by 5 points on the visual analogue scale for pain after undergoing selective nerve blocks. Postoperative assessment was done by a team that did not include the surgeon who did the denervation. The technique for selective knee denervation is described in detail. All 15 patients had at least 1 of the nerves to the knee selectively denervated (45 nerves in 15 patients). All patients reported subjective improvement in the immediate postoperative period. This improvement was maintained at a mean followup of 12 months (range, 6-16 months). Selective knee denervation is indicated in the management of intractable knee pain of neuroma origin after total knee arthroplasty.
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Development and prevention of running-related osteoarthritis
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OAK 3 - Non-arthroplasty tx of OAK
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Studies investigating the effect of running on risk for developing osteoarthritis at weight-bearing joints have reported with conflicting results. Generally, moderate-level running is not likely detrimental to joint health. However, many factors may be associated with the increased risk of developing osteoarthritis in runners. Factors often implicated in the development of osteoarthritis comprise those that increase joint vulnerability and those which increase joint loading. It is therefore suggested that running has different effects on different people. Efforts should be made to identify those with joint vulnerability and joint loading, and measures should be taken to have those factors and/or their running programs modified to run safely. Further investigations are needed to examine the effect of running on joint health under different conditions to confirm the association between exposure to risk factors and development of osteoarthritis, as well as to validate the effectiveness of measures for preventing running-related osteoarthritis.
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Comparing leukocyte-rich platelet-rich plasma injection with surgical intervention for the management of refractory tennis elbow. A prospective randomised trial
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PRPs for Lateral Epicondylitis/Elbow Tendinopathies
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Background: Patients with ongoing symptoms after non-operative treatment of lateral epicondylosis are usually treated with surgical release. Platelet-rich plasma injection is an alternative treatment option. This study aims to determine whether there is a difference in outcome from platelet-rich plasma injection or surgical release for refractory tennis elbow.
Method: Eighty-one patients with a diagnosis of tennis elbow for a minimum of six months, treated with previous steroid injection and a minimum visual analogue scale pain score of 50/100 were randomised to open surgery release (41 patients) or leucocyte rich platelet-rich plasma (L-PRP) (40 patients). Patients completed the Patient-Rated Tennis Elbow Evaluation and Disability of the Arm Shoulder and Hand at baseline, 1.5, 3, 6 and 12 months post-intervention. The primary endpoint was change in Patient-Rated Tennis Elbow Evaluation pain score at 12 months.
Results: Fifty-two patients completed final follow-up. Functional and pain scores improved in both groups. No differences in functional improvements were found but greater improvements in Patient-Rated Tennis Elbow Evaluation pain scores were seen after surgery. Thirteen patients crossed over from platelet-rich plasma to surgery within 12 months, and one surgical patient underwent a platelet-rich plasma injection.
Conclusion: L-PRP and surgery produce equivalent functional outcome but surgery may result in lower pain scores at 12 months. Seventy per cent of patients treated with platelet-rich plasma avoided surgical intervention.
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Differences in risk factor patterns between cervical and trochanteric hip fractures
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Management of Hip Fractures in the Elderly
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The two types of hip fracture - cervical and trochanteric femoral fractures - are generally considered together in etiologic studies. However, women with a trochanteric fracture may be more osteoporotic than those with cervical hip fractures, and have higher post-fracture mortality. To explore differences in risk factor patterns between the two types of hip fracture we used data from a large population-based case-control study in Swedish women, 50-81 years of age. Data were collected by questionnaire, to which more than 80% of subjects responded. Of the cases included, 811 had had a cervical fracture and 483 a trochanteric fracture during the study period; these cases were compared with 3312 randomly selected controls. Height and hormonal factors appeared to affect the risk of the two types of hip fracture differently. For every 5 cm of current height, women with a cervical fracture had an adjusted odds ratio (OR) of 1.23 (95% CI 1.15-1.32) compared with an OR of 1.06 (95% CI 0.97-1.15) for women with trochanteric fractures. Later menopausal age was protective for trochanteric fractures (OR 0.95, 95% CI 0.91-0.99 per 2 years) but no such association was found for cervical fractures. Compared with never smokers, current smokers had an OR of 1.48 (95% CI 1.12-1.95) for trochanteric fractures and 1.22 (95% CI 0.98-1.52) for cervical fractures. Current hormone replacement therapy was similarly protective for both fracture types, but former use substantially reduced risk only for trochanteric fractures: OR 0.55 (95% CI 0.33-0.92) compared with 1.00 (95% CI 0.71-1.39) for cervical fractures. These risk factor patterns suggest etiologic differences between the fracture types which have to be considered when planning preventive interventions
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0 |
Psychosocial consequences of road accidents
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DoD PRF (Psychosocial RF)
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Presents data from a 3-yr retrospective follow-up study concerning psychosocial outcome of 51 children injured in traffic accidents and the implications for 55 relatives of 112 adults who had suffered some consequences from an accident. An analysis was also performed of a subsample of 192 road traffic injured Ss included in a previously reported study by U. F. Malt et al (see record 1990-17636-001). 7.8% of the children had behavioral problems, 4.1% had impaired playing ability, and 14.3% had reduced physical performance capacity. Overall, the 20% activity decrease, the frequent reports of long-term depressive and anxiety symptoms, and the psychosocial implications for the relatives of the victims indicate that the psychiatric and psychosocial consequences of traffic injuries are a major cause of reduced mental health. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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An original application of the Endotine Ribbon device for brow lift
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Upper Eyelid and Brow Surgery
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BACKGROUND: Correction of brow ptosis and lateral temporal laxity is one of the goals of surgical rejuvenation of the aging face. The Endotine Forehead (Coapt Systems, Inc., Palo Alto, Calif.) device is an effective bioabsorbable fixation tool for forehead and brow-lift procedures. However, the Endotine Forehead device alone is not able to correct lateral brow ptosis and temporal laxity. In this article, the authors propose an innovative use of another special device, the Endotine Ribbon (Coapt Systems), to provide long-lasting results in lateral brow-lift surgery and temporal lateral laxity correction. METHODS: Between February of 2006 and April of 2007, a total of 30 patients, aged between 38 and 70 years (average, 50 years), underwent brow-lift surgery. With this technique, the Endotine Ribbon is cut in halves and each portion of it is anchored to the deep temporal fascia with sutures, and its multiple tines facing outward grasp the superficial temporal fascia. The amount of brow elevation produced was assessed by comparison of the preoperative and postoperative vertical distances between the superior eyebrow hairline and the midpupil and lateral and medial canthal angle. The average follow-up period was 18 months. RESULTS: Using this technique, perfectly symmetric lateral eyebrows and temporal laxity correction were obtained in all patients. A lasting result was observed, and no significant adverse events were encountered. CONCLUSIONS: The application of the Endotine Ribbon for brow-lift procedures provides significant and reproducible lateral brow elevation and temporal laxity correction. This fixation method is effective, safe, and easy to use, and leads to high patient satisfaction.
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0 |
The association of preoperative delirium with postoperative outcomes following hip surgery in the elderly
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Hip Fx in the Elderly 2019
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STUDY OBJECTIVE: To determine the association of preoperative delirium with postoperative outcomes following hip surgery in the elderly.
DESIGN: Retrospective cohort study.
SETTING: Postoperative recovery.
PATIENTS: 8466 patients all of whom were 65years of age or older undergoing surgical repair of a femoral fracture. Of the total population studied, 1075 had preoperative delirium. Of those with preoperative delirium, 746 were ASA class 3 or below and 327 were ASA class 4 or above. Of the 7391 patients without preoperative delirium, 5773 were ASA class 3 or below and 1605 were ASA class 4 or above. The remainder in each group was of unknown ASA class.
INTERVENTIONS: We used multivariable logistic regression to explore the association of preoperative delirium with 30-day postoperative outcomes. The odds ratio (OR) with associated 95% confidence interval (CI) was reported for each covariate.
MEASUREMENTS: Data was collected regarding the incidence of postoperative outcomes including: delirium, pulmonary complications, extended hospital stay, infection, renal complications, vascular complications, cardiac complications, transfusion necessity, readmission, and mortality.
MAIN RESULTS: After adjusting for potential confounders, the odds of postoperative delirium (OR 9.38, 95% CI 7.94-11.14), pulmonary complications (OR 1.83, 95% CI 1.4-2.36), extended hospital stay (OR 1.47, 95% CI 1.26-1.72), readmission (OR 1.27, 95% CI 1.01-1.59) and mortality (OR 1.92, 95% CI 1.54-2.39) were all significantly higher in patients with preoperative delirium compared to those without.
CONCLUSIONS: After controlling for potential confounding variables, we showed that preoperative delirium was associated with postoperative delirium, pulmonary complications, extended hospital stay, hospital readmission, and mortality. Given the lack of studies on preoperative delirium and its postoperative outcomes, our data provides a strong starting point for further investigations as well as the development and implementation of targeted risk-reduction programs.
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0 |
Controversies in clinical endodontics: Part 3. Filling from the open position
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
Controversies have been common in the clinical treatment of endodontically involved teeth for many years. This series of articles discusses the advantages and disadvantages of three of the major disagreements in the field at this time. They are: (1) What is the significance of lateral canals and how are they best filled? (2) Should treatment be completed in a single appointment or should multiple appointments be involved? And (3) Can the canal(s) be filled after the tooth is left open or should such treatment be avoided? This article discusses filling from the open position
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0 |
Three-dimensional MRI of the musculoskeletal system
|
AMP (Acute Meniscal Pathology)
|
OBJECTIVE. The purposes of this review are to describe commonly available 3D MRI techniques and to discuss the literature to date regarding the utility of such techniques in the assessment of internal derangement of joints. CONCLUSION. Long acquisition and postprocessing times and limited contrast characteristics have generally prohibited routine use of 3D MRI in clinical practice. However, technical advances, including higher-field-strength MRI systems, high performance gradients, high-resolution multichannel coils, and pulse sequences with shorter acquisition times, have made feasible 3D isotropic MRI with reasonable acquisition times. © American Roentgen Ray Society.
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0 |
(iv) The patella in total knee replacement
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OAK 3 - Non-arthroplasty tx of OAK
|
The role and management of the patella in total knee replacement remains controversial. The patella is an important sesamoid bone, with a rich vascular and neural network surrounding it, and it must be managed appropriately in order to ensure a satisfactory outcome after a total knee replacement. The controversies concern arguments for and against resurfacing as well as other considerations influencing the decision surrounding the management of the patella. There is sufficient evidence within the orthopaedic literature to support pretty much any reasonable decision that the surgeon might make. Ultimately, to resurface, not to resurface or to selectively resurface the patella is an operator-dependent decision, and in association with a good prosthetic design and surgical technique satisfactory and comparable results can be achieved. © 2013 Elsevier Ltd.
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1 |
Preoperative gait patterns and BMI are associated with tibial component migration
|
Surgical Management of Osteoarthritis of the Knee CPG
|
BACKGROUND AND PURPOSE: There is no standard for patient triage in total knee arthroplasty (TKA) based on joint functional characteristics. This is largely due to the lack of objective postoperative measurement of success in TKA in terms of function and longevity, and the lack of knowledge of preoperative metrics that influence outcome. We examined the association between the preoperative mechanical environment of the patients knee joint during gait and the post-TKA stability of the tibial component as measured with radiostereometric analysis (RSA).METHODS: 37 subjects were recruited out of a larger randomized RSA trial. 3-dimensional gait analysis was performed in the preoperative week. Longitudinal RSA data were gathered postoperatively at 6 months and 1 year.RESULTS: We found a statistically significant association between the pattern of the knee adduction moment during gait preoperatively and the total migration of the implant at 6 months postoperatively. A substantial proportion of the variability in the total postoperative tibial component migration (R(2) = 0.45) was explained by a combination of implant type, preoperative knee joint loading patterns during gait, and body mass index at 6 months postoperatively. The relationships did not remain statistically significant at 1 year postoperatively.INTERPRETATION: Our findings support the hypothesis that preoperative functional characteristics of patients, and particularly joint loading patterns during activities of daily living, are important for outcome in TKA. This represents a first step in the development of predictive models of objective TKA outcome based on preoperative patient characteristics, which may lead to better treatment strategies. ClinicalTrials.gov (NCT00405379)
|
1 |
Preoperative skin traction for fractures of the proximal femur. A randomised prospective trial
|
Hip Fx in the Elderly 2019
|
We report the results of a randomised trial to determine the effects of skin traction on 252 patients awaiting surgery for fractures of the proximal femur. They were allocated randomly to be nursed free in bed or to receive Hamilton-Russell skin traction. No differences were found between the groups in terms of pain suffered, analgesia required, frequency of pressure sores or ease of operation. The application of skin traction to patients with fractures of the upper femur is time-consuming and we recommend therefore that its routine use should be discontinued.
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0 |
Static external fixation of the wrist
|
Distal Radius Fractures
|
Historical evolution in concepts, indications, application, reduction techniques, and the rehabilitation program and complications of external fixation of the wrist are discussed. Indirect reduction techniques using overdistraction and flexion are recommended. Additional stabilization of the epiphysis allows immediate reduction of overdistraction, thus eliminating the potential complications related to overdistraction. Used with the due attention to detail, external fixation of the wrist is a rewarding and efficient treatment method. [References: 24]
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0 |
Detecting bacterial colonization of implanted orthopaedic devices by ultrasonication
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
Glycocalyx-producing bacteria have been observed on orthopaedic devices that were removed for reasons other than infection. It has been suggested that the bacteria adhere to foreign surfaces within a biofilm and elude standard culture techniques. The authors adapted previously used ultrasonication protocols that disrupt the surface biofilm before culturing removed orthopaedic devices from patients without clinical evidence of infection. Patients having revision total joint arthroplasty of the hip or knee who lacked current or prior clinical evidence of infection were studied prospectively. During surgery, the femoral component and a corresponding control femoral implant were placed in separate sterile bags of saline. The implant and saline combination was placed in an ultrasonication bath for 30 minutes at 60 Hz. The saline solution was passed through a 0.45-microm pore filter, and the filter residue was cultured on sheep blood agar. None of the 21 implants yielded positive culture on routine microbiologic testing. However, using the ultrasonication protocol, a coagulase-negative Staphylococcus grew from one of the removed implants. Numerous total joint implant failures that are attributed to aseptic loosening may be a result of subclinical infection from bacteria within a biofilm. The current study supports the concept that biofilm-protected bacterial colonization of implants may occur without overt signs of infection and ultrasonication can be used to enhance identification of these bacteria
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0 |
Open fracture of the tibia in children
|
DoD SSI (Surgical Site Infections)
|
The records of eighty-three children who had had an open fracture of the tibial metaphysis or diaphysis between January 1983 and July, 1993 were studied retrospectively. The average duration of follow-up was fourteen months (range, two to seventy-five months). There were twenty-four grade-I, forty grade-II, thirteen grade-IIIA, six grade-IIIB, and no grade-IIIC fractures, according to the classification scheme of Gustilo et al. Sixty patients (72 per cent) had sustained the fracture when they were struck by an automobile, and forty-eight patients (58 per cent) had other associated major injuries. All fractures were treated with irrigation and debridement, and antibiotics were administered parenterally for a minimum of forty-eight hours. Thirty-two patients were managed with immobilization in a cast only; forty, with transcutaneous fixation with an average of two Steinmann pins followed by immobilization in a cast; nine, with external fixation; one, with open reduction and internal fixation with two screws and two pins; and one, with delayed intramedullary nailing. Fifty-seven wounds were closed primarily (forty-four, over a Penrose drain, and thirteen, without a drain), ten were treated with delayed closure, four were allowed to heal by secondary intention, seven were covered with a soft-tissue flap, and five were treated with skin-grafting (a split-thickness skin graft was used for four, and a split-thickness and a full-thickness skin graft were used for one). The average time to union was fifteen weeks (range, five to sixty-one weeks), with the fracture healing by sixteen weeks in sixty-four patients (77 per cent). Eighteen patients (22 per cent) had delayed union, and only one patient (1 per cent) had non-union. Secondary procedures were necessary to achieve union in only two patients. Two patients had a superficial wound infection, and no patient had osteomyelitis. One patient, who had been managed with external fixation, had a pin-track infection; none of the patients who had had transcutaneous fixation had a pin-track infection. Two patients had a compartment syndrome, and two patients had a transient stretch injury of a nerve (the peroneal nerve in one and the sciatic nerve in the other). Four fractures healed with an angulatory deformity of more than 10 degrees in any plane. Five patients had overgrowth of the limb of one centimeter or more. Physeal arrest did not occur in any patient. We concluded that treatment of unstable open fractures of the tibia in children with debridement and transcutaneous fixation followed by immobilization in a cast leads to good anatomical and functional results. We prefer this technique to external fixation, which is associated with several potential complications. Loose closure of a clean open wound over a Penrose drain is effective and can be safely utilized in selected children.
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0 |
Hospitalization costs of total knee arthroplasty with a continuous femoral nerve block provided only in the hospital versus on an ambulatory basis: a retrospective, case-control, cost-minimization analysis
|
AAHKS (4) Acetaminophen
|
BACKGROUND AND OBJECTIVES: After total knee arthroplasty (TKA), hospitalization may be shortened by allowing patients to return home with a continuous femoral nerve block (CFNB). This study quantified the hospitalization costs for 10 TKA patients receiving ambulatory CFNB versus a matched cohort of 10 patients who received CFNB only during hospitalization.
METHODS: We examined the medical records (n = 125) of patients who underwent a unilateral, primary, tricompartment TKA with a postoperative CFNB by 1 surgeon at one institution in an 18-month period beginning January 2004. Each of the 10 patients discharged home with an ambulatory CFNB (cases) was matched with a patient with a hospital-only CFNB (controls) for age, gender, body mass index, and health status. Financial data were extracted from the hospital microcosting database.
RESULTS: Nine patients with ambulatory CFNB (cases) were discharged home on postoperative day (POD) 1 and 1 on POD 4. Of the controls, 3 were discharged home on POD 3, 6 on POD 4, and 1 on POD 5. The median (range) costs of hospitalization (excluding implant and professional fees) was US dollars 5,292 (US dollars 4,326-US dollars 7,929) for ambulatory cases compared with US dollars 7,974 (US dollars 6,931-US dollars 9,979) for inpatient controls (difference = US dollars 2,682, 34% decrease, P < .001). The total charges for hospitalization, the implant, and professional fees was US dollars 33,646 (US dollars 31,816-US dollars 38,468) for cases compared with US dollars 39,100 (US dollars 36,096-US dollars 44,098) for controls (difference = US dollars 5,454, 14% decrease, P < .001).
CONCLUSIONS: This study provides evidence that ambulatory CFNB for selected patients undergoing TKA has the potential to reduce hospital length of stay and associated costs and charges. However, the current study has significant inherent limitations based on the study design. Additional research is required to replicate these results in a prospective, randomized, controlled trial and to determine whether any savings exceed additional CFNB costs such as from complications, having caregivers provide care at home, and additional hospital/health care provider visits.
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0 |
Histochemical analyses of tissue-engineered human menisci
|
AMP (Acute Meniscal Pathology)
|
The field of tissue engineering remains one of the least explored areas of current meniscal research but holds great promise. In this investigation, meniscal fibrochondrocytes were isolated from fresh human meniscal tissue and seeded onto synthetic polyglycolic acid (PGA) scaffolds. Constructs were implanted into the dorsal subcutaneous space of athymic nude mice. Control scaffolds, devoid of meniscal cells, were simultaneously implanted in additional mice. Constructs were harvested over 12 weeks and treated with a variety of histochemical stains to analyze general specimen morphology, cellular viability and proliferation, and collagen secretion. Results indicate that meniscal fibrochondrocyte proliferation increased over the time of implantation with cellular consolidation occurring as the PGA scaffolding was progressively hydrolyzed. Collagen production also increased over time. There were favorable similarities between constructs and human meniscal controls in terms of cellular morphology, phenotypic expression, and collagen production. These initial findings demonstrate procedures supporting proliferation of meniscal fibrochondrocytes, expression of fibrochondral phenotype, and the formation of putative meniscal tissue.
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0 |
Functional outcome of Schatzker type V and VI tibial plateau fractures treated with dual plates
|
DoD SSI (Surgical Site Infections)
|
BACKGROUND: Dual plate fixation in comminuted bicondylar tibial plateau fractures remains controversial. Open reduction and internal fixation, specifically through compromised soft tissues, has historically been associated with major wound complications. Alternate methods of treatment have been described, each with its own merits and demerits. We performed a retrospective study to evaluate the functional outcome of lateral and medial plate fixation of Schatzker type V and VI fractures through an anterolateral approach, and a medial minimally invasive approach or a posteromedial approach.
MATERIALS AND METHODS: We treated 46 tibial plateau fractures Schatzker type V and VI with lateral and medial plates through an anterolateral approach and a medial minimal invasive approach over an 8 years period. Six patients were lost to followup. Radiographs in two planes were taken in all cases. Immediate postoperative radiographs were assessed for quality of reduction and fixation. The functional outcome was evaluated according to the Oxford Knee Score criteria on followup.
RESULTS: Forty patients (33 men and 7 women) who completed the followup were included in the study. There were 20 Schatzker type V fractures and 20 Schatzker type VI fractures. The mean duration of followup was 4 years (range 1-8 years). All patients had a satisfactory articular reduction defined as <=2 mm step-off or gap as assessed on followup. All patients had a good coronal and sagittal plane alignment, and articular width as assessed on supine X-rays of the knee in the anteroposterior (AP) and lateral views. The functional outcome, as assessed by the Oxford Knee Score, was excellent in 30 patients and good in 10 patients. All patients returned to their pre-injury level of activity and employment. There were no instances of deep infection.
CONCLUSIONS: Dual plate fixation of severe bicondylar tibial plateau fractures is an excellent treatment option as it provides rigid fixation and allows early knee mobilization. Careful soft tissue handling and employing minimal invasive techniques minimizes soft tissue complications.
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0 |
Secondary patellar resurfacing in the treatment of patellofemoral pain after total knee arthroplasty
|
PJI DX Updated Search
|
PURPOSE: This paper reports a prospective review of patients who, between 2004 and 2007, underwent secondary patellar resurfacing (SPR) due to anterior knee pain after a primary total knee arthroplasty (TKA). The aim was to evaluate the clinical outcomes obtained with the SPR and to compare them with radiological findings. METHODS: A total of twenty-seven consecutive patients met the inclusion criteria. There were twenty-three (85%) women and four (15%) men with a median age of 70 years. The patients were evaluated before and after the surgery with the same functional scores and radiological parameters. Bone scintigraphy was also used in the assessment, and a CT-scan was performed in order to evaluate the femoral component rotation. The median time between TKA and SPR was 18 months. RESULTS: With a median follow-up of 23 months, seventeen patients (63%) reported a clear subjective improvement after SPR, and patellofemoral scores (primary outcome measure), KSS and WOMAC (secondary outcome measures) showed a statistically significant improvement following the procedure. There were no significant changes after SPR in the Insall-Salvati ratio, the lateral patellar displacement or the lateral patellar tilt. The mean time between TKA and SPR had no statistically significant effect on outcome. The bone scintigraphy revealed increased patellar uptake in seven cases, but this was not related to subsequent improvement after SPR. Rotational computed tomography showed a median internal rotation of the femoral component of 1 masculine. The complications observed were a patellar component loosening and an acute post-infection. CONCLUSION: No clinical or radiological parameter was found to be related to the final outcome after SPR. There was a discrepancy between functional scale scores and the patient's subjective satisfaction
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0 |
Effect of high impact exercise on femoral neck bone mineral density and T2 relaxation times of articular cartilage in postmenopausal women
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AMP (Acute Meniscal Pathology)
|
Unilateral, high impact exercise has been found to increase femoral neck bone mineral density (BMD) in older men and premenopausal women. Postmenopausal women are at increased risk of osteoporotic fracture and could benefit from an intervention to increase BMD but may be reluctant to participate in high impact exercise due to concern about knee joint damage. The aim of the current study was to evaluate the effects of high-impact exercise on femoral neck BMD and knee articular cartilage properties in postmenopausal women. Postmenopausal women were recruited into a six-month, unilateral exercise intervention. This progressed to 50 multidirectional hops each day, using a randomly assigned exercise leg for comparison with the contralateral control leg. Dual energy X-ray absorptiometry provided information on the BMD of both femurs. Coronal T2 maps using a 3.0T MRI scanner provided T2 relaxation times of knee articular cartilage in 12 regions of interest (ROIs) from a single slice in the weight bearing region. Scans were taken of both legs, pre and post intervention. Repeated measures ANOVA were carried out to analyse effects of leg, time and interaction.To date, 29 of the 43 participants have completed the study (age 61.1 ± 4.4 years; BMI 24. ± 3.7 kg/m2). Of these, 4 participants withdrew due to exercise related injury or discomfort (knee pain that resolved upon cessation of exercise [n=3], Achilles tendonitis [n=1]), 2 due to other injury or illness and 2 were lost to follow up. Femoral neck BMD increased by 0.73% in the exercise leg and decreased by 0.74% in the control leg, but this difference between legs did not reach statistical significance (P=0.067). There were no significant exercise effects on T2 relaxation times of knee cartilage (0.97>P>0.18): across the 12 ROIs changes ranged from -3.2 to 2.7% in the exercise leg and -6.1 to 4.6% in the control leg.The intervention was feasible but the incidence of withdrawal due to exercise related injury or discomfort suggests that modification may be desirable for postmenopausal women. That there were no significant changes in T2 relaxation times in healthy women agrees with previous research, in women with mild osteoarthritis, that high impact exercise does not adversely affect knee articular cartilage. Although not statistically significant, this brief, high impact exercise had similar net effects on femoral neck BMD in postmenopausal women (1.5%) as reported in a group of 35 older men (1.6%).
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0 |
Evidence-based management of the knee in hemophilia
|
AAHKS (2) Corticosteroids
|
" Hemophilia is among the commonest bleeding disorders encountered in orthopaedic practice and results from an Xchromosome- linked failure of coagulation factors VIII (hemophilia A) or IX (hemophilia B). " Morbidity in hemophilia is a result of repeated hemarthroses, and the aim of orthopaedic management is to prevent these, to treat them promptly, and to address the joint pathology that results. " Both radiosynovectomy and arthroscopic synovectomy are effective in reducing the degree of synovitis and the number of hemarthroses, although, to our knowledge, there is little evidence that it prevents progression to end-stage arthritis. There is substantial evidence for the safety and effectiveness of radiosynovectomy, and this is the first line of treatment in our practice. " In end-stage disease, total knee arthroplasty is challenging as a result of severe contractures and is associated with a higher rate of complications such as infection (7% compared with 1% to 2% in osteoarthritis) and need for blood transfusions and a higher revision rate than that seen in total knee arthroplasty for osteoarthritis. " However, many series of total knee arthroplasty for hemophilia have now been published, and excellent results can be gained in terms of pain relief and quality of life. .
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0 |
Clinical outcome and cost comparison of carpal tunnel wound closure with monocryl and ethilon: a prospective study
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
This prospective non-randomised two-cohort study compares the use of an absorbable suture (Poliglecrapone [Monocryl]: Group A) and a non-absorbable suture (Polyamide [Ethilon]: Group B) in wound closure after elective carpal tunnel decompression. The primary outcome was scar cosmesis as assessed by the Stonybrook Scar Evaluation Scale (SBSES); the financial cost of wound closure was compared as a secondary outocome. All fifty patients completed follow-up. At six weeks, there was no significant difference in the two groups regarding scar tenderness (p = 0.5), although residual swelling was more evident in the absorbable group (p = 0.2). The mean SBSES score at six weeks was 4.72 in Group A, and 4.8 in Group B (p = 0.3). The unit cost per closed wound of Monocryl was three times than Ethilon (p < 0.05). Ethilon is thus cost-effective without compromising the cosmetic outcome, and we recommend using this as the preferred suture for closure of carpal tunnel wounds
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0 |
Physiotherapy alone or in combination with corticosteroid injection for acute lateral epicondylitis in general practice: a protocol for a randomised, placebo-controlled study
|
The Treatment of Pediatric Supracondylar Humerus Fractures AUC
|
BACKGROUND: Lateral epicondylitis is a painful condition responsible for loss of function and sick leave for long periods of time. In many countries, the treatment guidelines recommend a wait-and-see policy, reflecting that no conclusions on the best treatment can be drawn from the available research, published studies and meta-analyses. METHODS/DESIGN: Randomized double blind controlled clinical trial in a primary care setting. While earlier trials have either compared corticosteroid injections to physical therapy or to naproxen orally, we will compare the clinical effect of physiotherapy alone or physiotherapy combined with corticosteroid injection in the initial treatment of acute tennis elbow. Patients seeing their general practitioner with lateral elbow pain of recent onset will be randomised to one of three interventions: 1: physiotherapy, corticosteroid injection and naproxen or 2: physiotherapy, placebo injection and naproxen or 3: wait and see treatment with naproxen alone. Treatment and assessments are done by two different doctors, and the contents of the injection is unknown to both the treating doctor and patient. The primary outcome measure is the patient's evaluation of improvement after 6, 12, 26 and 52 weeks. Secondary outcome measures are pain, function and severity of main complaint, pain-free grip strength, maximal grip strength, pressure-pain threshold, the patient's satisfaction with the treatment and duration of sick leave. CONCLUSION: This article describes a randomized, double blind, controlled clinical trial with a one year follow up to investigate the effects of adding steroid injections to physiotherapy in acute lateral epicondylitis
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0 |
Diagnosis of internal derangement of the Knee: Volume isotropic turbo spin-echo acquisition MRI with fat suppression versus without fat suppression
|
Osteochondritis Dissecans 2020 Review
|
OBJECTIVE. The purpose of this study was to compare 3D volume isotropic turbo spinecho acquisition (VISTA) MRI with and without fat suppression for use in evaluating ligaments, menisci, and cartilage. MATERIALS AND METHODS. Two radiologists retrospectively and independently reviewed 71 MRI studies. Each study consisted of 3D intermediate-weighted VISTA images with fat suppression and without fat suppression. The presence of tears of the anterior cruciate and posterior cruciate ligaments, tears of the medial and lateral menisci, and cartilaginous defects was evaluated. Arthroscopic surgical findings were used as the standard of reference. Statistical ana lysis was performed to calculate the sensitivity, specificity, and accuracy of the two methods. RESULTS. Mean specificity and accuracy for medial meniscal tears were significantly higher with VISTA (specificity, 95.0%; accuracy, 94.4%) than with fat-suppressed VISTA (FS-VISTA) (specificity, 81.3%; accuracy, 85.9%), and the difference was statistically significant (specificity, p = 0.003; accuracy, p = 0.004). Mean specificity for cartilaginous defects was also significantly higher with VISTA than with FS-VISTA (99.1% vs 96.8%, p = 0.039). There were no other significant differences between the two methods. CONCLUSION. Three-dimensional VISTA MRI has higher specificity than FS-VISTA imaging for evaluation of medial meniscal tears and cartilaginous defects.
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0 |
Hypertrophic polyosteopathy (Cadiot-Ball syndrome) secondary to a transitional urethral carcinoma metastased to the lung in a 9 years-old Border Collie
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MSTS 2018 - Femur Mets and MM
|
Hypertrophic osteopathy (Cadiot-Ball syndrome) is a rare condition involving a diaphyseal osteoperiosteal reaction of the long bones, most often of paraneoplastic origin, associated with primitive tumors of the lung or with pulmonary metastasis. A female Border Collie dog is referred for consultation for deformation of the four limbs associated with chronic hyperthermia over the course of one month and dysuria. Biochemical and hematological profiles did not reveal a major anomaly. The clinical exam reveals hyperthermia and bone deformation in the distal region of the femoral and humeral diaphyses and in the proximal region of the tibio-fibular and radio-ulnar diaphyses. Bladder distension and severe dysuria are also noted. The principal hypothesis is of a hypertrophic polyosteopathy. X-rays of the limbs highlight significant osteoproliferation of nearly all the osseous shafts. A thoracic X-ray shows several pulmonary masses. A vesical catheter allows a proximal urethral obstruction to be observed. Abdominal ultrasound reveals vesical distension as well as numerous masses in the trigonal region. Cytological analysis indicates transitional cell carcinoma of the epithelium. This case illustrates that the clinical manifestations of Cadiot-Ball syndrome generally appear before initial cancer symptoms, even when the cancer has already spread significantly.
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0 |
Evaluation of clinical outcomes of management of paediatric bone forearm fractures using titanium elastic nailing system: A prospective study of 50 cases
|
DoD SSI (Surgical Site Infections)
|
Introduction: Forearm fractures are common injuries in children. In older children, there management is difficult due to increased chances of re-displacement after closed reduction. Aim: The aim of this prospective study was to evaluate the clinical outcome of managing paediatric forearm fractures using Titanium Elastic Nailing System (TENS). Materials and Methods: A total of 50 patients in the age group 6 to 14 years with fractures in both bones of forearm were managed by internal fixation using TENS and prospective follow-up were done for six months. Results: On final evaluation in terms of symptoms and range of motion of adjacent joints using Price CT et al., criteria for results, we had excellent outcomes in 92% patients and good in 8%. There were no significant complications except for superficial pin tract infections at entry site of nail in only 6% of patients. Conclusion: We conclude that TENS is an effective and minimally invasive method of fixation of forearm fractures with excellent results in terms of bony union and functional outcomes with minimal complications and without jeopardizing the integrity of the physis.
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0 |
Local antibiotics: panacea for long term skeletal traction
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Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
Long periods of skeletal traction are frequently needed in busy tertiary centres due to long waiting lists for surgery. A frequent complication is pin track infection, which leads to revision of pin insertion or switching over to skin traction. A prospective study was conducted on sixty patients with upper tibial pin insertion for various causes. Antibiotic (injection Cephazolin 0.5 g after sensitivity testing--250 mg on each side) was injected on thirty patients at the site of pin insertion and no antibiotic was injected in 30 controls. Only one stage one pin track infection was seen in the study group (3% cases), where as six cases had stage 1 infection, one case had stage 2 infection and two cases had stage 3 infections in the control group (30% cases). This study showed the usefulness of this modification in preventing morbidity in patients who are planned for long-term skeletal traction by temporarily suppressing the local flora
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0 |
Outcome following a second hip fracture
|
Management of Hip Fractures in the Elderly
|
Hip fracture has a significant impact on medical resources and patient morbidity and mortality. Few patients admitted with a hip fracture are considered for prophylactic measures aimed at the reduction of further fracture risk. Currently, 10-13% of patients will later sustain a second hip fracture. In considering the possible role of prophylactic measures in the prevention of second hip fracture, we investigated whether second hip fracture has a significant further impact on patients' mobility and social independence. We also sought to identify a pattern to second hip fracture that may allow targeting of those patients who are most likely to benefit from currently available prophylactic measures. We undertook a retrospective review of 49 consecutive patients admitted with a second hip fracture between August 1999 and September 2000. Fewer patients maintained their ability to walk independently after the second fracture than did so after the first (53 and 91% respectively, P<0.0005). Following second hip fracture, patients' level of mobility determined their future social independence. Older patients and those with a history of multiple falls had a shorter time interval between fractures. Second hip fracture has a significant further impact on patients' mobility and social independence. Younger patients and those without a history of multiple falls are most likely to benefit from medical prophylaxis
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0 |
Risk Factors for Radiographic Progression of Osteoarthritis After Meniscus Allograft Transplantation
|
OAK 3 - Non-arthroplasty tx of OAK
|
PURPOSE: To identify risk factors that predict radiographic progression of osteoarthritis after meniscus allograft transplantation (MAT) using multivariate logistic regression.
METHODS: Inclusion criteria were consecutive patients who underwent medial or lateral MATs from January 2005 to September 2012 by one surgeon. Exclusion criteria were lack of postoperative magnetic resonance image, loss to follow-up for a minimum of 3 years, and simultaneous surgery on articular cartilage or the anterior cruciate ligament. According to the change of Kellgren-Lawrence (KL) grade at the mean final follow-up of 56.2 months, the enrolled MATs were sorted into the no progression of osteoarthritis (NOA) and progression of osteoarthritis (POA) groups. Multivariate logistic regression was used to analyze risk factors, including age, sex, body mass index, time from previous meniscectomy to MAT, extent of previous meniscectomy, previous anterior cruciate ligament reconstruction, knee alignment angle, KL grade, side of transplanted meniscus, Outerbridge grade, posterior repair technique, and relative percentage of extrusion.
RESULTS: In comparison between the NOA (n = 38) and the POA (n = 31) groups, a significant risk factor for radiographic progression of osteoarthritis after MAT was medial MAT compared with lateral MAT. Medial MAT compared with lateral MAT was also a significant risk factor (adjusted odds ratio, 3.763; 95% confidence interval, 1.212-11.683).
CONCLUSIONS: Patients need to be counseled about the increased risk of osteoarthritis progression after MAT over time, particularly for medial MAT.
LEVEL OF EVIDENCE: Level III, retrospective case control study.
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0 |
Avascular necrosis after chemotherapy for haematological malignancy in childhood
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AAHKS (2) Corticosteroids
|
Avascular necrosis (AVN) is a serious complication of high-dose chemotherapy for haematological malignancy in childhood. In order to describe its incidence and main risk factors and to evaluate the current treatment options, we reviewed 105 children with a mean age of 8.25 years (1 to 17.8) who had acute lymphoblastic or acute myeloid leukaemia, or a non-Hodgkin's lymphoma. Overall, eight children (7.6%) developed AVN after a mean of 16.8 months (8 to 49). There were four boys and four girls with a mean age of 14.4 years (9.8 to 16.8) and a total of 18 involved sites, 12 of which were in the femoral head. All these children were aged > nine years (p < 0.001). All had received steroid treatment with a mean cumulative dose of prednisone of 5967 mg (4425 to 9599) compared with a mean of 3943 mg (0 to 18 585) for patients without AVN (p = 0.005). No difference existed between genders and no thrombophilic disorders were identified. Their initial treatment included 11 core decompressions and two bipolar hip replacements. Later, two salvage osteotomies were done and three patients (four hips) eventually needed a total joint replacement. We conclude that AVN mostly affects the weight-bearing epiphyses. Its risk increases with age and higher steroid doses. These high-risk patients may benefit from early screening for AVN.
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0 |
Breast conservation surgery
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Reduction Mammoplasty for Female Breast Hypertrophy
|
Breast conservation therapy for early-stage invasive breast cancer provides survival equivalence to mastectomy. Careful patient selection and surgical technique are necessary to minimize local recurrence. Studies over the past fifteen years have identified the risk factors for local recurrence. Patients previously thought to be ineligible for breast conservation earlier like locally advanced breast cancer, macromastia, cancer in pregnant women can be managed by modified BCT approaches. Local recurrences should be managed aggressively as long term survival can be frequently achieved.
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0 |
Intraoperative Measurements of Joint Line Changes Using Computer Navigation Do Not Correlate With Postoperative Radiographic Measurements in Total Knee Arthroplasty
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OAK 3 - Non-arthroplasty tx of OAK
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BACKGROUND: The adverse effects of joint line (JL) changes on kinematics and outcomes of total knee arthroplasty (TKA) have been studied. Some authors have quantified JL changes using intraoperative data from computer navigation, despite no studies validating these measurements to date. We designed a prospective study to determine whether intraoperative measurements of JL changes using computer navigation correlate with measurements obtained on weight-bearing radiographs postoperatively.
METHODS: A total of 195 consecutive patients (195 knees) underwent computer-navigated cruciate-retaining TKA by the senior author. Twenty-four patients had missing radiographic data and were excluded from the study. The final JL change was calculated intraoperatively from the verified bony cuts and planned JL change as determined by the computer. JL position was also measured on preoperative and postoperative radiographs using an anteroposterior method.
RESULTS: One hundred seventy-one knees were evaluated. Using computer-navigated and radiographic measurements, the mean JL change was 1.95 +/- 1.5 mm (0-8.0 mm) and 4.05 +/- 2.9 mm (0-17.3 mm), respectively. One hundred fourteen (67%) vs 129 (75%) had JL elevation, 44 (26%) vs 30 (18%) had JL depression, and 13 (7%) vs 12 (7%) had no JL change, respectively. Inter-rater and intrarater reliability of radiographic measurements was excellent. We found a poor correlation between computer-navigated and radiographic measurements (r = 0.303).
CONCLUSION: There is a poor correlation between computer-aided and radiographic measurements of JL changes post-TKA. Elevation/depression of the JL needs to be considered in patients who remain symptomatic despite TKA, although the optimal method of assessment remains uncertain.
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Efficacy and safety of human parathyroid hormone-(1-84) in increasing bone mineral density in postmenopausal osteoporosis
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Management of Hip Fractures in the Elderly
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Daily sc injections of N-terminal analogs of PTH increase bone mass and decrease fractures in osteoporotic women. We investigated the efficacy and safety of human PTH-(1-84) (full-length PTH) in the treatment of postmenopausal osteoporosis in a double-blind, placebo-controlled study. The women (n = 50-53/group) self-administered PTH (50, 75, or 100 microg) or placebo by daily sc injection for 12 months. PTH treatment induced time- and dose-related increases in lumbar spine bone mineral density (BMD). The 100-microg dose increased BMD significantly at 3 months (+2.0%) and 12 months (+7.8%). BMD underestimated the anabolic effect of PTH in lumbar spine (bone mineral content, +10.0%) because bone area increased significantly (+2.0%). A nonsignificant decrease (-0.9%) in total hip BMD occurred during the first 6 months with the 100-microg dose, but this trend reversed (+1.6%) during the second 6 months. Bone turnover markers increased during the first half of the study and were maintained at elevated levels during the second 6 months. Protocol compliance was excellent (95-98%), and treatment was generally safe and well tolerated. Dose-related incidences of transient hypercalcemia occurred, but only one patient (100-microg group) was withdrawn because of repeated hypercalcemia. Thus, full-length PTH was efficacious and safe over 12 months
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Blood transfusion and drainage catheter clamping are associated with ecchymosis formation at the surgical site after total knee arthroplasty: An analysis of 102 unilateral cases
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OAK 3 - Non-arthroplasty tx of OAK
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Background: Many previous studies have focused on the postoperative complication of postoperative knee pain, infection, knee prosthesis loosening, periprosthetic fractures, and so on. There have been few studies focused on postoperative ecchymosis formation surrounding the wound of the TKA site. A certain degree of effect on the early functional recovery of the patients may occur due to the mental stress caused by the ecchymosis, which raises doubts regarding the success of the surgery. Therefore, it is particularly important to understand the risk factors for postsurgical ecchymosis formation after TKA, and specific measures for preventing ecchymosis should be taken. In this study, we reviewed the record of patients who received TKAs in our hospital, and a comprehensive analysis and assessment was conducted regarding 15 clinical factors causing postsurgical ecchymosis formation. Methods: The records of 102 patients who received unilateral TKAs between January 2007 and May 2010 were retrospectively analyzed. Patients were divided into two groups based on the occurrence of ecchymosis. Results: Of the 102 patients, 14 (13.7%) developed ecchymosis. Blood transfusion and drainage catheter clamping during the first few postoperative hours had a significant impact on the development of ecchymosis (p < 0.05). There was no difference in age, BMI, operation time, pre- and postoperative platelet count, and length of postoperative anticoagulant therapy between the two groups. Multivariate logistic regression revealed major risk factors for ecchymosis were postoperative blood transfusion (odds ratio (OR) = 15.624) and drainage catheter clamping (OR 14.237) (both, p < 0.05). Conclusion: Blood transfusion and drainage catheter clamping after TKA due to excessive blood suction were associated with higher risks for ecchymosis formation surrounding the surgical site. © 2012 Springer-Verlag.
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Revision hip arthroplasty in the octogenarian Is it worth it?
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Management of Hip Fractures in the Elderly
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We retrospectively reviewed the clinical and patient perceived results of 76 revision hip arthroplasties performed in 68 octogenarians since 1990. 60% of patients gained a worthwhile reduction in pain. In contrast to previous studies, however, the functional level of the majority of patients did not improve. 29% of patients felt that they gained no benefit from their operation and, with the benefit of hindsight, 24% of patients would not have consented to surgery, from which they found recovery harder than their first operation. 47% of patients suffered complications which were multiple in over a quarter. There was a 17% dislocation rate which was usually recurrent and rarely salvageable. The indication for revision surgery in the octogenarian must be pain of sufficient severity to justify these risks
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Modulation of the host response in periodontal therapy
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Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
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This paper was prepared by the Research, Science, and Therapy Committee of the American Academy of Periodontology to provide the dental profession an overview of current and potential methods to modulate the host response in the treatment of periodontal diseases. Specifically, it discusses components of periodontal disease pathogenesis (i.e., immune and inflammatory responses, excessive production of matrix metalloproteinases and arachidonic acid metabolites, and regulation of bone metabolism) and their modulation
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Biomechanics in uniaxial compression of three distal radius volar plates
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Distal Radius Fractures
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Purpose: A new fixed-angle volar plate for a dorsally displaced distal radius fracture was designed with the aim of avoiding soft tissue problems due to dorsal plating. The purpose of this study was to compare the biomechanical properties of this new plate with 2 existing volar plates in a cadaver model. Methods: Three different plates were applied on surgically simulated unstable extra-articular distal radius fractures in formalin-fixed cadaver radiuses. Group 1 (volarly placed AO titanium Distal Radius plates [Synthes Ltd, Paoli, PA]; n = 6), group 2 (volarly placed titanium Symmetry plates [DePuy ACE Co, El Segundo, CA]; n = 6), and group 3 (volarly placed newly designed titanium plates; n = 6) were tested to failure under axial compression with a materials testing machine. Specimens of all 3 groups had similar bone mineral density. Results: Group 3 specimens had significantly greater elastic limit and ultimate strength than the other 2 groups. Specimens of group 3 had the greatest rigidity, although this was statistically insignificant compared with the other 2 groups. All plates (groups 1, 2, 3) failed in apex volar angulation. Conclusions: The newly designed plate fixation system is the strongest of the systems tested and may offer adequate stability for the treatment of a distal radius fracture in which the dorsal and/or volar metaphyseal cortex is comminuted severely. Copyright © 2004 by the American Society for Surgery of the Hand.
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Three- to six-year follow-up results after high-flexion total knee arthroplasty: can we allow passive deep knee bending?
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Surgical Management of Osteoarthritis of the Knee CPG
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PURPOSE: We evaluated 3- to 6-year clinical and radiological follow-up results after NexGen(R) LPS-flex total knee arthroplasty (TKA). METHODS: A retrospective evaluation was undertaken of 218 knees in 166 patients (22 males, 144 females) who were followed up for more than 3 years after TKA. Evaluations included preoperative and postoperative range of motion (ROM) measurement, Knee Society (KS) Score, tibiofemoral angle and assessment of postoperative complications. RESULTS: TKA resulted in a significant ROM increase from a mean flexion contracture of 9 degrees (range 0 degrees -20 degrees ) and further flexion of 117 degrees (range 80 degrees -155 degrees ) to a mean flexion contracture of 2 degrees (range 0 degrees -10 degrees ) and a further flexion of 131 degrees (range 95 degrees -155 degrees ). KS knee and function scores significantly improved from 52 and 38 before surgery to 87 and 82 after surgery, respectively. The tibiofemoral angle significantly improved from varus 5.7 degrees to valgus 5.4 degrees . Progressive radiolucent lines around the femoral component on radiographs were observed in 30 knees (13.8%, 27 patients), and more of those knees, could squat than non-radiolucent knees (76.7 vs. 20.2%; P<0.05). Seven knees (3.2%, 6 patients) were revised at a mean 49 months after the index operation. CONCLUSIONS: While NexGen(R) LPS-flex TKA satisfactorily improved ROM, it was associated with a relatively high incidence of early loosening of the femoral components. This might be associated with passive-maximal flexion activity, such as squatting or kneeling. The clinical relevance of this study is that squatting or kneeling, common activity in Asian, may not be allowed after NexGen(R) LPS-flex TKA
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The weight-bearing scanogram technique provides better coronal limb alignment than the navigation technique in open high tibial osteotomy
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OAK 3 - Non-arthroplasty tx of OAK
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BACKGROUND: Successful outcomes following high tibial osteotomy (HTO) require precise realignment of the mechanical axis of the lower extremity. The present study investigated whether the weight-bearing limb scanogram (WBS) technique provided a more accurate mechanical axis realignment than the navigation technique in open high tibial osteotomy (OHTO).
METHODS: This prospective study involved 80 knees (78 patients) undergoing OHTO. The WBS technique was used in 40 knees and the navigation technique in 40 knees. Each technique was performed by a different surgeon in a different hospital. Postoperative coronal limb alignment was assessed using the weight-bearing line (WBL) ratio on full-length standing hip-to-ankle radiographs.
RESULTS: We found that the mean postoperative WBL ratio was greater in the WBS compared to the navigation group (p=0.001), and hence the ratio for the WBS group was closer to the ratio target of 62%. There was a greater proportion of WBL ratio outliers in the navigation group than the WBS group (25% vs. 10%, p=0.034).
CONCLUSION: We conclude that the WBS technique was more accurate than the navigation technique for restoration of coronal leg alignment in OHTO.
LEVEL OF EVIDENCE: Level II.
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Patellar dislocation: arthroscopic patellar stabilization with anchor sutures
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AMP (Acute Meniscal Pathology)
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There are many procedures to treat recurrent patellar subluxations and dislocations. Most of these procedures are open repairs for acute conditions or open reconstructions for chronic conditions, and both surgeries need large skin incisions. Although there are many arthroscopic procedures for meniscal and ligament injuries, there are very few arthroscopic procedures described for patellofemoral instability. In this report, we describe a new arthroscopic method to stabilize the patella for acute dislocation. Our technique includes an arthroscopic lateral release and a medial structure repair. We suggest that this procedure is minimally invasive and easier than traditional open procedures. Moreover, this may prevent patients from developing chronic instability of the patellofemoral joint.
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The reliability and validity of the Tekdyne hand dynamometer: Part II
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Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
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The purpose of this study was to evaluate the reliability and validity of the Tekdyne hand dynamometer for measuring grip strength as compared with the Jamar dynamometer. Additionally, it was hypothesized that one to six weeks after carpal tunnel release (CTR) grip strength would appear to be greater when tested on a softer tool than when tested on the Jamar dynamometer. The Tekdyne, the standard Jamar instrument (SJ) and a Jamar dynamometer modified with foam padding (MJ) were compared in 48 subjects without upper-extremity abnormality and 30 subjects following open-palm CTR. The Tekdyne and the Jamar hand dynamometers were well correlated in the presence and in the absence of upper-extremity abnormality (r = 0.975 and r = 0.871, respectively). Tekdyne intrasession reliabilities in both the non-surgical group and the surgical group were high (ICC = 0.954, SEM = 0.290 psi and ICC = 0.958, SEM = 0.219 psi). The Tekdyne intersession reliability of the non-surgical group was high (ICC = 0.971, SEM = 0.22 psi). There was no statistically significant difference between the ratios of the non-operated grip strengths across the three measurement devices, suggesting that the softer device did not promote greater force production by the operated hand
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Quantification of wrist motions during scanning
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Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
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A laboratory study was performed to help assess the risk of cumulative trauma disorders (CTDs) associated with the use of scanners in the grocery store environment. In this study experienced and inexperienced cashiers scanned a set of 12 standard grocery items using 19 different combinations of scanners, scanner orientations, and check stands. The motion characteristics of both wrists in three-dimensional space were documented and used as dependent measures of performance. These motions were compared with wrist motion benchmarks of high- and low-risk wrist accelerations. It was found that, in general, scanning motions are of sufficient magnitude to contribute to CTDs of the wrist. It was also found that wrist motion characteristics were greatly influenced by the different combinations of scanners, scanner orientations, and check stand designs. It was concluded that the 'front- style' check stand minimizes potentially injurious wrist motions because it permits the checker to split the scanning task between the two hands. The type of scanner and scanner orientation that minimized potentially injurious wrist motions was much more unique to the individual workstation condition. Additionally, it appears that scanners perceived by the checkers as needing fewer wrist deviations, such as those with slanted windows, also minimize wrist motions. The implications of these findings for the ergonomic design of the workplace are discussed
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1 |
Conservative mastectomies and immediate reconstruction with the use of ADMs
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Acellular Dermal Matrix
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BACKGROUND: In recent years, a novel approach to immediate breast reconstruction has been introduced with the advent of acellular dermal matrix (ADM). In the setting of conservative mastectomies where the native skin envelope is preserved, placement of ADM at the lower pole in continuity with the pectoralis major muscle (PMM) provides additional support, allowing direct-to-implant breast reconstruction. The following manuscript presents the senior author's experience with ADM-assisted reconstruction and provides a detailed description of surgical technique along with a comprehensive discussion of patient selection and potential complications. METHODS: A retrospective chart review of patients undergoing direct-to-implant breast reconstruction following skin sparing or nipple sparing mastectomy with the use of ADM (AlloDerm; LifeCell Corp., Branchburg, USA) was conducted at Women's College Hospital in Toronto over a 5-year period [2008-2013]. Demographic data, previous radiation therapy and post-operative complications were recorded. RESULTS: A total of 72 patients representing 119 breasts were identified. Average follow-up was 16 months (range, 3-51 months). Twenty-seven complications were recorded for a complication rate of 22.7% (27/119). Complications included six cases of capsular contracture (Baker III/IV), five cases of red skin syndrome, four cases of rippling, three cases of dehiscence and two cases of seroma. Overall, direct-to-implant reconstruction was successfully completed in 97.5% of breasts (116/119). One case of infection was treated with explantation and conversion to autogenous reconstruction. Two breasts with tissue necrosis or dehiscence had the implants removed and replaced with tissue expanders. Overall reoperation rate was 9.7% (7/72 patients). CONCLUSIONS: ADM assisted direct-to-implant breast reconstruction has been shown to be a safe option for women who are candidates for skin sparing or nipple sparing mastectomies. Judicious patient selection, effective collaboration between the oncologic and reconstructive surgeon, careful evaluation of post-mastectomy skin flaps and precise surgical technique are paramount to the success of this technique.
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Abdominal compartment syndrome
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DoD - ACS - Interrater Reliability
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OBJECTIVE: The purpose of this article is to discuss the pathogenesis, clinical features, radiologic findings, and treatment of abdominal compartment syndrome, which is defined as an acute elevation of the intraabdominal pressure with organ dysfunction.
CONCLUSION: Abdominal compartment syndrome is not well reported in the radiology literature. In this review, we discuss a range of CT signs such as elevated diaphragm, collapsed inferior vena cava, bowel wall thickening, bowel mucosal hyperenhancement, hemoperitoneum, and increasing abdominal girth, which, in combination, may allow the radiologist to raise the possibility of abdominal compartment syndrome. [References: 33]
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Treatment of Paradoxical Adipose Hyperplasia following Cryolipolysis: A Single-Center Experience
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Panniculectomy & Abdominoplasty CPG
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Paradoxical adipose hyperplasia is a rare adverse event associated with cryolipolysis. No evidence of spontaneous resolution has been described and little has been written about its treatment. The purpose of this report is to share the authors' experience treating patients with paradoxical adipose hyperplasia after cryolipolysis. A retrospective chart review was performed for all paradoxical adipose hyperplasia patients seen in the authors' practice between May of 2013 and May of 2016. The treatment parameters, demographics, onset of findings, and subsequent treatment were chronicled. Eleven cases of paradoxical adipose hyperplasia were identified (eight men and three women). All patients were of Hispanic background. Seven patients were treated surgically (six cases of liposuction alone and one case of liposuction and abdominoplasty). Average follow-up was 9.6 months (range, 2 to 32 months). Three of the patients treated with liposuction required a secondary procedure. All surgically treated patients were very satisfied with their final appearance. Paradoxical adipose hyperplasia is a rare complication of cryolipolysis that may occur more frequently than in the manufacturer's reported data. Treatment is best delayed until the affected area has softened, which normally occurs in 6 to 9 months after the initial cryolipolysis procedure. Power-assisted liposuction is the preferred method of treatment, but in some cases, abdominoplasty may be necessary. Secondary treatments might be needed for recurrence or persistent bulge. One must be sensitive to heightened patient concerns when offering an invasive procedure to correct the complications from a noninvasive one. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
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Early surgery for patients with a fracture of the hip decreases 30-day mortality
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Hip Fx in the Elderly 2019
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There has been extensive discussion about the effect of delay to surgery on mortality in patients sustaining a fracture of the hip. Despite the low level of evidence provided by many studies, a consensus has been accepted that delay of > 48 hours is detrimental to survival. The aim of this prospective observational study was to determine if early surgery confers a survival benefit at 30 days. Between 1989 and 2013, data were prospectively collected on patients sustaining a fracture of the hip at Peterborough City Hospital. They were divided into groups according to the time interval between admission and surgery. These thresholds ranged from < 6 hours to between 49 and 72 hours. The outcome which was assessed was the 30-day mortality. Adjustment for confounders was performed using multivariate binary logistic regression analysis. In all, 6638 patients aged > 60 years were included. Worsening American Society of Anaesthesiologists grade (p < 0.001), increased age (p < 0.001) and extracapsular fracture (p < 0.019) increased the risk of 30-day mortality. Increasing mobility score (p = 0.014), mini mental test score (p < 0.001) and female gender (p = 0.014) improved survival. After adjusting for these confounders, surgery before 12 hours improved survival compared with surgery after 12 hours (p = 0.013). Beyond this the increasing delay to surgery did not significantly affect the 30-day mortality.
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Early protected weightbearing after open reduction internal fixation of ankle fractures
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DoD SSI (Surgical Site Infections)
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The present retrospective study assessed the complications and loss of reduction in 126 patients aged 16 years or older who bore weight in a short leg cast within 15 days after surgical repair of acute unilateral closed ankle fractures from January 1997 to December 2003. Fracture reduction was assessed on immediate postoperative and weightbearing digital radiographs at least 6 weeks after surgery. The medical records were reviewed for postoperative complications. Complete radiographs were available for 81 patients. The mean follow-up period was 171 (range 42 to 1275) days. The mean patient age was 50 years. Patients began walking an average of 8 days after surgery. From the medical record review, no cases of malunion or nonunion occurred. A total of 14 complications developed in 12 (9.5%) of 126 patients, including a delay in wound healing in 6, nerve paresthesia in 5, and hardware migration in 1. The patients aged 60 years or older had a slightly greater overall complication rate (6 of 38, p = .18). Patients who walked on postoperative day 1 had slightly more wound problems (2 of 19, p = .36). Of the 81 ankle fracture radiographs, 80 (98.8%) showed no displacement in fracture reduction on the final follow-up examination. One patient had a 2-mm loss of fracture reduction and was allowed to walk on postoperative day 1 (p = .09). These results support early protected weightbearing after operative treatment of closed isolated lateral malleolar and bimalleolar ankle fractures without syndesmotic involvement in patients of all ages.
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Demographic and socioeconomic factors influencing the incidence of clavicle fractures, a national population-based survey of five hundred and twelve thousand, one hundred and eighty seven individuals
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DoD PRF (Psychosocial RF)
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Background: This study aims to investigate the population-based incidence of clavicle fracture and the related risk factors in China. Methods: All the data on clavicle fractures were available from the China National Fracture Survey (CNFS) database performed in 2015. In the CNFS, all eligible household members were sampled from eight provinces, 24 urban cities, and 24 rural counties in China, using stratified random sampling and the probability proportional to size method. Questionnaires were sent to every participant for data collection. Information on age, gender, height, weight, ethnic group, education, professional, smoking, alcohol consumption, sleeping time per day, dietary habits, and others was collected. Fracture case was identified by patientsâ?? self report and further confirmation by medical data. Results: A total of 512,187 valid questionnaires were collected, and relevant data were extracted and analyzed. There were 89 patients with 89 clavicle fractures in 2014, indicating that the incidence was 17.4 (95%CI, 13.8â??21.0) per 100,000 person-years. Traffic accidents and falls were the most predominant cause for clavicle factures, leading to 91.0% of all the injuries. Over 85% of them occurred on the road and at home. Age of 45â??64, average sleep time OpenSPiltSPi seven hours/day, smoking, alcohol consumption and history of previous fracture were identified as independent risk factors for clavicle fracture. Overweight (BMI, 24.0â??27.9) was a significant protective factor, which was estimated to reduce 72% of the clavicle fractures, compared to normal BMI (18.5â??23.9). Conclusions: Public health policies focusing on decreasing alcohol consumption, smoking cessation, and encouraging individuals to obtain sufficient sleep should be implemented. Middle-aged individuals with previous history of fracture should strengthen the awareness of prevention and health care and decrease risky activities to reduce the clavicle fractures.
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Articular cartilage sleeve fracture of the lateral humeral condyle capitellum: a previously undescribed entity
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The Treatment of Pediatric Supracondylar Humerus Fractures AUC
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Salter-Harris type IV fractures of the lateral humeral condyle are well-recognized injuries that have been previously described and classified. The case of an 11-year-old boy who sustained an unusual fracture of the distal humerus with the free fragment composed of 75% of the articular cartilage of the capitellum is presented. The cartilage was attached to only a thin shell of subchondral capitellar bone in continuity with the lateral aspect of the distal humeral physis and metaphysis. Radiographs did not show the magnitude of the articular cartilage component of the fracture, although physical examination was significant for elbow crepitus through a limited range of motion. Open reduction and internal fixation were necessary to achieve a congruous joint and restore anatomic alignment
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A histologic and immunohistochemical study of calcium pyrophosphate dihydrate crystal deposition disease
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AMP (Acute Meniscal Pathology)
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The articular cartilage, synovial membrane, and meniscus from ten patients who had calcium pyrophosphate dihydrate (CPPD) crystal deposition disease showed strong immunoreactivity for dermatan sulfate proteoglycan, Type I collagen, and S-100 protein in hypertrophic chondrocytes around the crystals, their pericellular matrix, and deposits of the crystals. Electron microscopy revealed that small crystals were formed around the hypertrophic chondrocytes, especially in the degenerated matrix containing electron-dense granular materials and cellular debris. Chondrocytes of this kind were never observed in the articular tissue from ten patients who had osteoarthrosis. These hypertrophic chondrocytes with several unique immunohistochemical characteristics may initiate the formation of CPPD crystals.
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Correlation between nipple elevation and breast resection weight: How to preoperatively plan breast reduction
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Reduction Mammoplasty for Female Breast Hypertrophy
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Breast hypertrophy is often associated with functional limitations. Beyond the aesthetic concerns, breast reduction can improve symptoms and self-esteem. In different countries, health-care system regulations have fixed the threshold for reimbursement in 500 g of predicted tissue resection for each breast. Different preoperative measurements have been proposed to predict breast-tissue weight to be removed, showing a variable correlation with post-operative evaluation. We describe a reliable, simple measurement to predict the quantity of breast reduction in grams, which can be applicable to any surgical technique. A total of 128 patients undergoing bilateral breast reduction were evaluated. The correlation between the preoperative nipple-areola complex (NAC) lift distance and the weight of removed breast tissue was tested with linear regression and Pearson's test. Other anthropometric measurements were tested as a control. The ratio between resected grams and lift distance was explored to find a multiplication coefficient to be used at preoperative planning. The mean resection weight was 686.65 g. The mean NAC-lift distance was 7.6 cm. Positive correlation between the NAC-lift distance and the weight of breast tissue removed was found (r: 0.87; p < 0.001). The mean weight of the removed breast tissue (g) per centimetre of NAC lift was 81 g/cm in the group between 6 and 12 cm and 70 g/cm in the group with >12 cm of lift distance. The NAC-lift distance is a single, objective, repeatable measure that can provide a reliable prediction of breast-tissue grams to be removed; it helps in classifying breast-reduction indications.
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Mechanism of irrigation effects on gingivitis
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Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
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Although gingivitis is initiated by plaque and plaque removal controls gingivitis, gingival irrigation with water has been shown to reduce gingivitis without reducing plaque. This study attempted to explore possible mechanisms involved in the treatment of gingivitis by water irrigation. Patients (n = 125) with more than 20 teeth, less than 4 sites with probing depth (PD) deeper than 6 mm, bleeding on probing (BOP) frequency of 30% or higher, and no systemic disease were randomized to one of four treatment groups: toothbrushing alone (brush), toothbrushing plus chlorhexidine 0.12% rinse 2x/day (CHX), toothbrushing plus water irrigation 1x/day (irr+H2O), or toothbrushing plus chlorhexidine 0.04% irrigation 1x/day (irr+CHX). Six sites/tooth were examined at baseline, and at 3 and 6 months for BOP and PD using an automated probe, and for gingival index (GI) and plaque index (PI) by standard means. A prophylaxis and oral hygiene instructions were provided after baseline and 6 month measurements. Subgingival microbial samples and crevicular fluid (GCF) were collected from 2 teeth/subject at each time point. Microbial samples were processed for anaerobic culture and the predominant cultivable flora was determined. CHX and irr+CHX had a 30 to 35% decrease in mean PI, while brush and irr+H2O had only a 12 to 16% decrease. BOP was reduced by 14% in the brush group and 23 to 24% in the other groups. GI was significantly correlated with PI in the brush, CHX, and irr+CHX groups, but not in the irr+H2O group. Prevotella intermedia was significantly reduced in both irrigation groups, but not CHX or brush groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Clinical observation on effect of xian-zhong injection on treating primary knee OA
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OAK 3 - Non-arthroplasty tx of OAK
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OBJECTIVE: To research and evaluate the clinical efficacy of Xianâ?zhong injection in treating primary knee OA. METHODS: By using Lequesne instituted ISOA and Kellgrenâ?Lawrance instituted Xâ?ray class standard, 127 nonâ?operation primaary knee OA patients were divided into three grades (Light, Moderate, Severe). To adopt randomized single controlled trial, each grade was divided into two groups, respectively injected Xianâ?zhong injection or Sodium Hyaluronate injection. Every injection's volume was 2 ml and injected one per week, then consecutively injected one month. Finally we followed up in the first month, third month, sixth month, afterward we did every six months. RESULTS: After followed up one â? twentyâ?four months we found ISOA score less than thirteen and Kâ?LA Xâ?ray class standard less than III grade, the clinical efficacy of two kind of injections was better. But ISOA score more than thirteen and Kâ?LA Xâ?ray class standard mord than III grade, the clinical efficacy was bad. The followâ?up showed that the total effective rate and excellent rate between Xianâ?zhong injection group and Sodium Hyaluronate injection group weren't significantly different. CONCLUSION: Xianâ?zhong injection can improve the clinical efficacy of primary knee OA, it has the greatest researching value and using furthermore.
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No-Scar Breast Reduction Utilizing Power-Assisted Liposuction Mammaplasty, Loops, and Lipofilling
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Panniculectomy & Abdominoplasty CPG
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BACKGROUND: In continued interest to develop and refine minimally invasive procedures, recent publications reported a scarless approach in breast lifting. OBJECTIVES: The authors sought to describe a power-assisted lipomodeling technique combined with surgical loops to achieve breast reduction and reshaping with minimal scars. METHODS: Between 2014 and 2018, 94 patients underwent breast reduction by combined liposuction and loops. Following infiltration of the breasts, liposuction of the outer quadrants and the lower pole was achieved to reduce the breast footprint and the lateral and inferior heaviness of the breast. After multiaxial multiplanar tunnelization, 3 types of loops were taken around the breast to suspend and elevate the breast skin envelope and parenchyma. Each loop was guided through a 3-mm, 3-hole cannula passed through skin stab incisions. The first loop was designed to reduce the breast footprint and enhance the breast projection, whereas the second loop was designed to achieve breast conus remodeling. The third loop was passed circumferentially around the areola and then cephalad along the breast axis and pulled until the desired nipple-areola complex elevation was reached. Each loop was pulled to achieve the desired breast projection and shape. RESULTS: The authors achieved breast reduction with a mean nipple elevation of 7.3 cm, and 88% of patients were satisfied with their breast shape. The total complication rate was 1%, including mild cellulitis in 1 breast, treated efficiently with oral antibiotics. CONCLUSIONS: The proposed technique is a novel, simple, and safe alternative to achieve breast reduction and reshaping without a scar.
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Competitive bass anglers: a new concern in sports medicine
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Pediatric Supracondylar Humerus Fracture 2020 Review
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Objective: Competitive bass angling involves sport fishing against other anglers while targeting a species of fish known as the black basses. Due to the rapidly growing popularity of high school competitive bass angling in Alabama and the nature of the casting motion similar to that of overhead athletes, we sought to examine the prevalence of sports type injuries in this population. Methods: In spring 2016, an anonymous survey was distributed across two large scale competitive high school fishing tournaments, allowing for a broad sampling of anglers throughout the state of Alabama. Survey items included demographic information, relevant past medical history, and various pains associated with the shoulder, elbow and wrist. Results were recorded and analyzed electronically using Microsoft Excel and IBM SPSS statistical software. Results: A total of 257 surveys were recorded. The response rate was 61%. The mean age of participating anglers was 15 ± 1.61 years. The majority (42%) of anglers fished year round. On average, anglers casted nearly 1,000 more times while competing versus fishing recreationally. Approximately 15% of anglers experienced shoulder, elbow, and wrist pain. The most common factors associated with pain included higher tournament cast counts, number of competitive years, number of tournaments/year, number of tournaments, and use of light weight lures. Conclusion: A large portion of high school competitive anglers experience upper extremity pain. Knowledge of angling factors associated with pain allow for the creation of a modifiable routine to help reduce pain in affected anglers and prevent pain in healthy anglers.
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Comparison of the efficacy and safety of dual-opioid treatment with morphine plus oxycodone versus oxycodone/acetaminophen for moderate to severe acute pain after total knee arthroplasty
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AAHKS (4) Acetaminophen
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BACKGROUND: In acute pain models, coadministration of low doses of morphine and oxycodone markedly enhanced analgesia relative to either opioid given alone. Enhanced analgesia with coadministration of morphine and oxycodone has also been reported in acute and chronic moderate to severe pain conditions during double-blind studies.
OBJECTIVE: The goal of this study was to compare the efficacy and tolerability of a flexible dose regimen of the morphine/oxycodone combination versus oxycodone/acetaminophen and fixed low-dose morphine/oxycodone.
METHODS: This was a 5-center, randomized, open-label study of hospitalized patients (n = 44) with acute moderate to severe postoperative pain after total knee arthroplasty. Inpatients were randomized to a flexible dose regimen of morphine/oxycodone (3 mg/2 mg to 24 mg/16 mg), fixed low-dose morphine/oxycodone regimen (3 mg/2 mg), or oxycodone/acetaminophen (5 mg/325 mg). Treatment was initiated following surgery after intravenous (IV) morphine patient-controlled analgesia. An algorithm was evaluated for converting the patient-controlled analgesia morphine dose to an initial oral dose of morphine/oxycodone. The primary efficacy variable was the time-weighted sum of pain intensity difference from 0 to 48 hours.
RESULTS: The median values for the sum of the pain intensity difference from 0 to 48 hours for the morphine/oxycodone flexible dose and oxycodone/acetaminophen were similar and approximately twice that of fixed morphine/oxycodone 3 mg/2 mg (148.0, 139.5, and 71.3, respectively). Moderate to severe gastrointestinal adverse events occurred in 50% of patients in the oxycodone/acetaminophen group compared with 15% of the equianalgesic morphine/oxycodone group. On several items of the Brief Pain Inventory (general activity, walking ability, and sleep), the morphine/oxycodone flexible dose produced greater benefit than oxycodone/acetaminophen.
CONCLUSIONS: Flexible dose morphine/oxycodone was superior to low-dose morphine/oxycodone and comparable to oxycodone/acetaminophen. Flexible dose morphine/oxycodone-treated patients had a lower rate of moderate to severe nausea or vomiting than equianalgesic oxycodone/acetaminophen-treated patients. Thus, morphine/oxycodone offers an attractive alternative to oxycodone/acetaminophen for the management of moderate to severe postoperative pain.
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0 |
Deep inferior epigastric artery perforator flap harvest after full abdominoplasty
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Panniculectomy & Abdominoplasty CPG
|
Abdominal scars are no longer a contra-indication for abdominal perforator flap harvesting. Few research data exists about the regeneration potential of the abdominal wall's perforator system. Therefore, previous abdominoplasty with umbilical transposition is an absolute contra-indication for a DIEaP-flap (deep inferior epigastric artery perforator flap). A 50-year-old patient required a breast reconstruction of the right breast, 10 years after an abdominoplasty with undermining of the superior abdomen and umbilical transposition. The patient was scheduled for a free lumbar artery perforator (LaP) flap. The preoperative computed tomography-angiography mapping showed nice lumbar perforators and to our surprise a good-sized DIEa perforator in the peri-umbilical region. The DIEa perforator on the right hemi-abdomen, consisting of two veins and one artery, was pulsatile and found suitable in size. A classical flap harvest and transfer was further performed. This case report is the first in which a dominant perforator is found in the area of undermining after a full abdominoplasty with umbilical repositioning. Further investigations regarding the nature and timing of re-permeation or regeneration of perforators after abdominoplasty are to be done. Nevertheless, we are convinced that with appropriate perforator mapping and a suitable plan B, previous abdominoplasty is no longer an absolute but a relative contra-indication for performing DIEaP-flap.
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0 |
A 42-year-old patient presenting with femoral head migration after hemiarthroplasty performed 22 years earlier: a case report
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PJI DX Updated Search
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INTRODUCTION: Treatment of femoral neck fractures in young adults may require total hip arthroplasty or hip hemiarthroplasty using a bipolar cup. The latter can, however, result in migration of the femoral head and poor long-term results. CASE PRESENTATION: We report a case of femoral head migration after hemiarthroplasty performed for femoral neck fracture that had occurred 22 years earlier, when the patient (a Japanese man) was 20 years old. He experienced peri-prosthetic fracture of the femur, subsequent migration of the prosthesis, and a massive bone defect of the pelvic side acetabular roof. After bone union of the femoral shaft fracture, the patient was referred to our hospital for reconstruction of the acetabular roof. Intra-operatively, we placed two alloimplants of bone from around the transplanted femoral head into the weight-bearing region of the acetabular roof using an impaction bone graft method. We then implanted an acetabular roof reinforcement plate and a cemented polyethylene cup in the position of the original acetabular cup. Eighteen months post-operatively, X-rays showed union of the transplanted bone. CONCLUSIONS: Treatment of femoral neck fractures in young adults is usually accomplished by osteosynthesis, but it may be complicated by femoral head avascular necrosis or by infection or osteomyelitis. In such cases, once an infection has subsided, either hip hemiarthroplasty using a bipolar cup or total hip arthroplasty may be required. However, if the acetabular side articular cartilage is damaged, a bipolar cup should not be used. Total hip arthroplasty should be performed to prevent migration of the implant
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0 |
Efficacy of rapid recovery protocol for total knee arthroplasty: a retrospective study
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PJI DX Updated Search
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OBJECTIVE: Our aim was to compare the clinical results and cost-effectiveness of a rapid recovery protocol for total knee arthroplasty (TKA) with a current standard protocol. METHODS: The study included patients undergoing primary elective TKA with at least 6 months of follow-up. The rapid recovery protocol was applied to 96 patients (Group 1) and the standard protocol to 108 (Group 2). All patients underwent standard TKA. All pre-, peri-, and postoperative procedures in the treatment and follow-up of patients were appropriately standardized to the philosophies of the different treatment plans. The postoperative length of hospital stay, total financial cost, postoperative surgical infection, 6-month American Knee Society scores, and knee range of motion (ROM) were compared between the groups. RESULTS: A total of 169 patients were included. Group 1 patients had significantly shorter postoperative length of hospital stay (p=0.021), significantly lower mean total financial cost (p=0.041), significantly lower infection rates (p=0.034), and significantly higher 6-month knee function scores (p=0.032). In comparison with Group 2, Group 1 knee flexion (p=0.04) and extension (p=0.48) ROM at 6 months postoperatively were both significantly improved. CONCLUSION: Application of the rapid recovery protocol to patients who underwent TKA reduced costs and infection rates and improved functional results
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0 |
Blinding in acupuncture research: A systematic review of randomized controlled trials for pain using a sham acupuncture control
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SR for PM on OA of All Extremities
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Objective: To study the various methods and levels of blinding in acupuncture research. Data sources: Reference lists of the most recent systematic review of acupuncture on pain, systematic search of MEDLINE from 1966 to August 2000, CINAHL from 1982 to August 2000, and HealthSTAR from 1975 to August 2000. Study selection: Randomized studies were included if they evaluated the effectiveness of acupuncture in painful conditions using a blinded design. Data extraction: The hard copy of each of the eligible studies available was reviewed. The following information was extracted: name of first author, publication year, study design, blinding testing, treatment sham group received, and the outcome measures. Data synthesis: There were 19 studies identified. They were described as 'double blinded' by the authors, referring to blinding of patients and evaluators. Sixteen studies did not perform any blinding testing after the treatments were over. Only three studies provided information that the blinding of patients was successful. These three studies used different questionnaires to assess the success of blinding. There was no study that evaluated the success of blinding of treatment evaluators. Also, no study attempted blinding of the treating acupuncturists. Conclusions: Proper blinding of patients and evaluators is possible in acupuncture research and many different techniques of proper blinding exist. Assessment of blinding is a critical aspect of any sham or placebo controlled trial and should be routinely incorporated into the design of such trials of acupuncture. (copyright) 2003 Elsevier Ltd. All rights reserved
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1 |
Serotype classification of Streptococcus mutans and its detection outside the oral cavity
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Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
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Streptococcus mutans, generally known as a major pathogen of dental caries, is also a possible causative agent of bacteremia and infective endocarditis. S. mutans is classified into serotypes c, e, f and k based on the chemical composition of serotype-specific polysaccharides, with approximately 70-80% of strains found in the oral cavity classified as serotype c, followed by e (approximately 20%), and f and k (less than 5% each). Serotype k was recently designated as a novel serotype and shown to possess unique features, the most prominent being a defect of the glucose side chain in serotype-specific rhamnose-glucose polymers, which is related to a higher incidence of detection in cardiovascular specimens, owing to phagocytosis resistance. Molecular analyses of cardiovascular specimens showed a high detection frequency for S. mutans DNA, among which the detection rate for serotype k was quite high. These findings suggest that serotype k S. mutans possibly has a high level of virulence for systemic diseases
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0 |
Are movement disorders and sensorimotor injuries pathologic synergies? When normal multi-joint movement synergies become pathologic
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Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
The intact nervous system has an exquisite ability to modulate the activity of multiple muscles acting at one or more joints to produce an enormous range of actions. Seemingly simple tasks, such as reaching for an object or walking, in fact rely on very complex spatial and temporal patterns of muscle activations. Neurological disorders such as stroke and focal dystonia affect the ability to coordinate multi-joint movements. This article reviews the state of the art of research of muscle synergies in the intact and damaged nervous system, their implications for recovery and rehabilitation, and proposes avenues for research aimed at restoring the nervous system's ability to control movement
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0 |
Psychosocial themes in durable employment transitions
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DoD PRF (Psychosocial RF)
|
Loss of work capacity through illness or injury may result in loss of employment. The transition to durable employment with those reduced capacities poses many challenges. This paper is based on phenomenological research into the experiences of 13 people (aged 26-54 years) who had a disabling injury or chronic illness. These participants lost their capacity for their former employment. After a period of time, extending up to 14 years, the participants successfully changed employment in the open labor market, and retained their current employment for 13 weeks or longer. Data from in excess of 30 hours of in-depth semi-structured individual interviews and a focus group were transcribed and analyzed inductively. Analysis was aided by immersion in the data, reflections on entries in a researcher's log, and a computer program for analyzing textual data. Eleven psychosocial themes emerged. These themes were: pain, intense emotions, determination, financial concerns, role models, concealment, assistance, control, self-concept, satisfaction with employment, and personal change. Each theme is presented with representative text from participants and implications for work rehabilitation professionals. Further research to identify the extent of transferability of the findings is recommended. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
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0 |
Platelet-rich plasma products in sports medicine
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PRPs for Lateral Epicondylitis/Elbow Tendinopathies
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Platelet-rich plasma (PRP) therapy is a recently developed technique that uses a concentrated portion of autologous blood to try to improve and accelerate the healing of various tissues. There is considerable interest in using these PRP products for the treatment of musculoskeletal disorders, particularly athletic injuries. Because PRP products are safe and easy to prepare and administer, there has been increased attention toward using PRP in numerous clinical settings. Platelet-rich plasma has been used to treat conditions such as lateral epicondylitis, ligament and muscle strains, and tears of the rotator cuff, anterior cruciate ligament, and Achilles tendon. Platelet-rich plasma can be applied at the site of injury either during surgery or through an injection performed in the physician's office. The benefits of PRP therapy appear to be promising, and many investigators are exploring the ways in which this therapy can be used in the clinical setting. However, there is little published clinical evidence that proves its efficacy in treating the multitude of injuries/disorders that are thought to benefit from PRP. The purpose of this article is to review the current evidence on PRP therapy.
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0 |
Evaluation of the esthetic surgery patient
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Panniculectomy & Abdominoplasty CPG
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A thorough evaluation, proper treatment planning, and honest discussion with esthetic surgery patients produce improved outcomes with greater operator and patient satisfaction. © 2004 Elsevier Inc. All rights reserved.
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0 |
Validation of occupational hand use categories
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Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
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As part of a study of the etiology of carpal tunnel syndrome in industry, we developed a measure of occupational hand use activities, "Occupational Hand Use" (OHU), using 471 workers from four industries. This categorization has five categories based primarily upon observed relative force and secondarily upon observed relative repetitions. Because the validity of this OHU categorization has been questioned, we devised a study to validate this variable by demonstrating its reliability. Using discriminant analysis, we show that the OHU categorization accurately reflects the subjective impressions of other industrial workers (605 workers from four other industries in the United States and Japan). Within each validation industry, 68 to 88% of all workers were classified precisely to the correct OHU category, and an additional 10 to 25% were classified to within one OHU category, for a hit or near-miss rate of 87 to 98%. The major classification error was due to some workers overestimating the repetitiousness of their jobs. An equation for calculating OHU from subjective or objective data is provided
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0 |
The stability of the hip after the use of a proximal femoral endoprosthesis for oncological indications: analysis of variables relating to the patient and the surgical technique
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MSTS 2022 - Metastatic Disease of the Humerus
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AIMS: Instability of the hip is the most common mode of failure after reconstruction with a proximal femoral arthroplasty (PFA) using an endoprosthesis after excision of a tumour. Small studies report improved stability with capsular repair of the hip and other techniques, but these have not been investigated in a large series of patients. The aim of this study was to evaluate variables associated with the patient and the operation that affect post-operative stability. We hypothesised an association between capsular repair and stability.
PATIENTS AND METHODS: In a retrospective cohort study, we identified 527 adult patients who were treated with a PFA for tumours. Our data included demographics, the pathological diagnosis, the amount of resection of the abductor muscles, the techniques of reconstruction and the characteristics of the implant. We used regression analysis to compare patients with and without post-operative instability.
RESULTS: A total of 20 patients out of 527 (4%) had instability which presented at a mean of 35 days (3 to 131) post-operatively. Capsular repair was not associated with a reduced rate of instability. Bivariate analysis showed that a posterolateral surgical approach (odds ratio (OR) 0.11, 95% confidence interval (CI) 0.02 to 0.86) and the type of implant (p = 0.046) had a significant association with reduced instability; age > 60 years predicted instability (OR 3.17, 95% CI 1.00 to 9.98). Multivariate analysis showed age > 60 years (OR 5.09, 95% CI 1.23 to 21.07), female gender (OR 1.73, 95% CI 1.04 to 2.89), a malignant primary bone tumour (OR 2.04, 95% CI 1.06 to 3.95), and benign condition (OR 5.56, 95% CI 1.35 to 22.90), but not metastatic disease or soft-tissue tumours, predicted instability, while a posterolateral approach (OR 0.09, 95% CI 0.01 to 0.53) was protective against instability. No instability occurred when a synthetic graft was used in 70 patients.
CONCLUSION: Stability of the hip after PFA is influenced by variables associated with the patient, the pathology, the surgical technique and the implant. We did not find an association between capsular repair and improved stability. Extension of the tumour often dictates surgical technique; however, our results indicate that PFA using a posterolateral approach with a hemiarthroplasty and synthetic augment for soft-tissue repair confers the lowest risk of instability. Patients who are elderly, female, or with a primary benign or malignant bone tumour should be counselled about an increased risk of instability. Cite this article: Bone Joint J 2017;99-B:531-7.
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0 |
Influence of age, sex and calendar year on lifetime accumulated red bone marrow dose from diagnostic radiation exposure
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MSTS 2022 - Metastatic Disease of the Humerus
|
Our aim is to evaluate the relevance of different factors influencing lifetime accumulated red bone marrow dose, such as calendar year, age and sex. The lifetime dose was estimated for controls interviewed in person (N = 2811, 37.5% women) of the population-based representative Northern Germany Leukemia and Lymphoma Study. Data were assessed in standardized computer-assisted personal interviews. The calculation of doses is based on a comprehensive quantification model including calendar year, sex, kind of examination, and technical development. In multivariate regression models the annual red bone marrow dose was analyzed depending on age, sex and calendar year to consider simultaneously temporal changes in radiologic practice and individual risk factors. While the number of examinations continuously rises over time, the dose shows two peaks around 1950 and after 1980. Men are exposed to higher doses than woman. Until 1970 traditional examinations like conventional and mass screening examinations caused the main dose. They were then replaced by technically advanced examinations mainly computed tomography and cardiac catheter. The distribution of the red bone marrow dose over lifetime depends highly on the technical standards and radiation protection survey. To a lesser extent it is influenced by age and sex of the subjects. Thus epidemiological studies concerning the assessment of radiation exposure should consider the calendar year in which the examination was conducted.
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0 |
New directions in surgical therapy
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Panniculectomy & Abdominoplasty CPG
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Surgical dermatology continues to evolve rapidly. The field is blessed with a number of bright and enthusiastic young surgeons who are willing to spend to necessary time investigating new techniques. The horizon has changed dramatically over the last 5 years and promises to change even more in the years to come.
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1 |
A randomized, double-blind, placebo-controlled 12 week trial of acetaminophen extended release for the treatment of signs and symptoms of osteoarthritis
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OAK 3 - Non-arthroplasty tx of OAK
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OBJECTIVE: Determine efficacy and safety of acetaminophen extended release (ER) 1300 mg given three times daily compared to placebo for relieving signs and symptoms of hip or knee osteoarthritis.
RESEARCH DESIGN AND METHODS: Sixty investigators at 58 private, ambulatory, primary care sites in the US enrolled 542 outpatient adults >=40 years old with moderate to severe idiopathic osteoarthritis pain into a randomized, placebo-controlled, double-blind 12 week clinical trial. Patients were randomly assigned to treatment given three times daily of acetaminophen 1300 mg (n = 267) or placebo (n = 275).
RESULTS: The three primary endpoints measured through week 12 favored acetaminophen ER as follows: least squares (LS) mean change from baseline for WOMAC physical function subscale score was significantly greater for acetaminophen ER than for placebo (P = 0.011); LS mean patient's global assessment of response to therapy was significantly greater for acetaminophen ER than for placebo (P = 0.010); and LS mean change from baseline for WOMAC pain subscale score was marginally greater for acetaminophen ER than for placebo (P = 0.054). LS mean change from baseline for secondary endpoints through week 12 also favored acetaminophen ER compared with placebo: significantly for WOMAC stiffness subscale score (P = 0.004), significantly for WOMAC total index score (P = 0.013), and marginally for Nottingham Health Profile energy subscale score (P = 0.057). The percentage of patients with any adverse event was similar for both treatment groups. Hepatic transaminases exceeded 3 x ULN in seven acetaminophen ER patients and one placebo patient. Elevations were attributed to health conditions in three of seven acetaminophen ER patients; elevations in the remaining four patients returned to or toward normal.
CONCLUSIONS: Acetaminophen ER 1300 mg, a nonprescription drug, given three times daily, can provide effective relief of signs and symptoms of osteoarthritis of the hip or knee and was well tolerated. ClinicalTrials.gov registration number: NCT00240799.
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0 |
Anatomical Prediction for Surgical Positioning of the Umbilicus in a Croatian Population
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Panniculectomy & Abdominoplasty CPG
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AIM: The umbilicus is an essential esthetic landmark on the abdominal wall in women and men. There are only few models published for predicting exact localization of the umbilicus. The aim of our study was to develop a mathematical model for predicting correct umbilical positioning in a sample of young women and men and in a sample of middle-aged women. In addition, we wanted to develop a predictive model applicable to both sexes. We applied our models with distinct anthropometric characteristics such as body mass index (BMI) and waist circumference (WC)/hip circumference (HC) to further expand our findings. METHODS: In this study, 98 Croatian women and men randomly selected from the University of Zagreb and 46 female patients awaiting abdominoplasty procedure at our institution were included. Anthropometric data and measurements between the umbilicus and fixed bony points around the anterior abdomen were collected. The data collected were body mass (BM), body height (BH), BMI, WC and HC, and waist-hip ratios (WHR). All collected data were subjected to standard statistical analyses. RESULTS: This study developed 2 different regressive equations for the most accurate prediction of exact umbilical localization. In women, the best prediction of the position of the umbilicus was based on the distance from the interanterior hypochondrium line to the umbilicus using the following regressive equation: u-i-hy = BM x 0.5799 + BH x -0.5051 + BMI x -1.8230 + WHR x -10.6364 + 89.6411. In men, the best prediction of the position of the umbilicus was based on the distance from the umbilicus to the interspinous line using the following regressive equation: u-i-is = age x 0.2033 + BM x 0.6445 + BH x -0.5692 + BMI x -2.2802 + WC x -0.0911 + 101.9408. METHODS: We found that age and anthropometric dimensions have a significant influence on the position of the umbilicus on the anterior abdominal wall. The naturally occurring anthropometric variations between women and men made the results of a unique predictive model for umbilical position inaccurate. We found that using 2 distinct predictive models, 1 for both subgroups of women and 1 for men, generated the most accurate predictive results. This quantitative tool should be applied to both women and men for the correct positioning of the umbilicus in reconstructive and esthetic procedures in which the original umbilical location is affected.
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0 |
Asymptomatic enlargement of the clavicle: A review of underlying aetiologies
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Glenohumeral Joint OA
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An asymptomatic enlargement of the medial clavicle is a condition that is often both missed and misdiagnosed. We review the most common causes of an isolated and asymptomatic enlargement of the medial clavicle. Underlying aetiologies include osteoarthritis of the sternoclavicular joint, condensing osteitis, spontaneous dislocation of the sternoclavicular joint, and sternocostoclavicular hyperostosis. Key points in the history and physical examination as well as characteristic radiographic findings are sufficient for correct diagnoses. Treatment is conservative. © 2010, Acta Orthopaedica Belgica.
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0 |
LeucoPatch in Malleoli Ulcer Study
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DoD LSA (Limb Salvage vs Amputation)
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Diabetic Foot Ulcers are a common and severe complication, that affects Patients Life Quality. Healing time is often long and the Diabetic foot ulcer is the dominating not traumatic reason for leg amputation. Treatment of a diabetic foot ulcer requires debridement, offloading, regularly foot care, specially tailored shoes, antimicrobial treatment, and sometimes even surgical interventions. Despite all these interventions the diabetic foot ulcer may not heal. Malleoli ulcers in patients without diabetes share several features of pathogenesis and lack of healing potentials with the Diabetic Ulcer. Like the features of pathogenesis and lack of healing potential and are therefore included in this study. Research has shown that other methods such as Growth factors may be a way to enhance the chance of healing. Growth Factors have been shown to have a positive effect in studies, but no products that are characterized as autologous have as yet obtained positive results in controlled studies. LeucoPatch is produced solely from a patientâ?¬â?¤s own blood without addition, and is autologous. LeucoPatch appears as an elastic membrane and can be fitted to the individual ulcer. LeucoPatch is shown to contain as many or more growth factors as existing products, and has a high concentration of fibrin, platelets and leukocytes. A nonÎ?Ã?Ã?controlled study was made on ulcers less than 10cm 2 and 52% had competed epithelization after 20 weeks. An International randomized multicenter trial is ongoing to evaluate the efficacy and safety of LeucoPatch on healing of hard to heal diabetic foot ulcers below the malleoli. This Study is designed to test the healing effect of the LeucoPatch on malleoli ulcers, the Patient will be randomized and the healing will be confirmed by a blinded observer.
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0 |
Chronic upper limb pain syndrome (repetitive strain injury) in the Australian workforce: a systematic cross sectional rheumatological study of 229 patients
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Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
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The epidemic of chronic upper limb pain is the most important and controversial issue in industrial rheumatology in Australia today. Two hundred and twenty-nine consecutive patients referred with chronic upper limb pain which had been labelled "repetitive strain injury" or "overuse syndrome" were assessed according to a protocol designed to give insight into the questions: Is the pain genuine or falsely reported, i.e., malingering? If genuine is it due to a physical injury, a pain syndrome, or a mixture of both? Twenty-nine patients fulfilled criteria for specific rheumatological diagnoses (fibrositis 15, rotator cuff syndrome 3, rheumatoid arthritis 3, cervical referred pain 3, lateral epicondylitis 2, de Quervain's tenosynovitis 1, carpal tunnel syndrome 1, and psoriatic monoarthritis 1). In the remaining 200 (mean age 37 years, range 19-58, 91.5% female) many different pain patterns and nonspecific associated symptoms were recorded. Eighty-nine percent had greater than or equal to 2 Smythe tender points, 1.5% had 1 tender point, and 9.5% had no tender point. Diffuse pain and greater than 7 tender points is sufficient to diagnose fibrositis, and localized pain and a smaller number of tender points strongly suggests a genuine chronic rheumatic pain syndrome. Stress, personal susceptibility and poor motivation appeared important in some cases. The liberal workers' compensation system, early labeling as repetitive strain injury, and social acceptability appeared important in the development of the epidemic
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0 |
Correlation between operative outcomes of cervical compression myelopathy and mri of the spinal cord
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MSTS 2022 - Metastatic Disease of the Humerus
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STUDY DESIGN: Magnetic resonance images of cervical compression myelopathy were retrospectively analyzed in comparison with surgical outcomes.
OBJECTIVES: To investigate which magnetic resonance findings in patients with cervical compression myelopathy reflect the clinical symptoms and prognosis, and to determine the radiographic and clinical factors that correlate with the prognosis.
SUMMARY OF BACKGROUND DATA: Signal intensity changes of the spinal cord on magnetic resonance imaging in chronic cervical myelopathy are thought to be indicative of the prognosis. However, the prognostic significance of signal intensity change remains controversial.
METHODS: The participants in this study were 73 patients who underwent cervical expansive laminoplasty for cervical compression myelopathy. Their mean age was 64 years, and the mean postoperative follow-up period was 3.4 years. The pathologic conditions were cervical spondylotic myelopathy in 42 patients and ossification of the posterior longitudinal ligament in 31 patients. Magnetic resonance imaging (spin-echo sequence) was performed in all the patients. The transverse area of the spinal cord at the site of maximal compression was computed, and spinal cord signal intensity changes were evaluated before and after surgery. Three patterns of spinal cord signal intensity changes on T1-weighted sequences/T2-weighted sequences were detected as follows: normal/normal, normal/high-signal intensity changes, and low-signal/high-signal intensity changes. Surgical outcomes were compared among these three groups. The most useful combination of parameters for predicting prognosis was determined using a stepwise regression analysis.
RESULTS: The findings showed 2 patients with normal/normal, 67 patients with normal/high-signal, and 4 patients with low-signal/high-signal change patterns before surgery. Regarding postoperative recovery, the preoperative low-signal/high-signal group was significantly inferior to the preoperative normal/high-signal group. There was no significant difference between the transverse area of the spinal cord at the site of maximal compression in the normal/high-signal group and the low-signal/high-signal group. A stepwise regression analysis showed that the best combination of surgical outcome predictors included age (correlation coefficient R = -0.348), preoperative signal pattern, and duration of symptoms (correlation coefficient R = -0.231).
CONCLUSIONS: The low-signal intensity changes on T1-weighted sequences indicated a poor prognosis. The authors speculate that high-signal intensity changes on T2 weighted images include a broad spectrum of compressive myelomalacic pathologies and reflect a broad spectrum of spinal cord recuperative potentials. Predictors of surgical outcomes are preoperative signal intensity change pattern of the spinal cord on radiologic evaluations, age at the time of surgery, and chronicity of the disease.
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0 |
Efficacy of Cooled and Monopolar Radiofrequency Ablation of the Geniculate Nerves for the Treatment of Chronic Osteoarthritic Knee Pain
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OAK 3 - Non-arthroplasty tx of OAK
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This is a single center randomized controlled trial. Approximately 102 patients will be randomized to one of two treatment groups: cooled radiofrequency or conventional monopolar radiofrequency ablation. Patients with chronic knee pain, with moderate to severe osteoarthritis according to the Kellgrenâ?Lawrence scale for at least 6 months who have failed conservative therapy will be screened for the study. Then, patients will be enrolled based on reporting â?¥50% pain relief after a fluoroscopic guided single diagnostic block of the geniculate nerves (superior medial, superior lateral, and inferior medial) with 0.5 ml of local anesthetic (2% Lidocaine). Baseline data will be collected for all enrolled patients. Outcomes will be measured at 1, 4, 12, 24 and 52 weeks. Outcome measures will be: Visual analogue scale (VAS) both while at rest and during ambulation, Oxford knee scores, WOMAC, and global perceived effect.
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0 |
Histological evaluation of the osteoinduction capability of human dentine
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Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
Aim To assess whether human dentine has the potential to promote the development of calcified tissues when implanted in the muscle tissue of mice. Methodology Root canals in extracted human teeth were instrumented to produce dentine fragments. The dentine fragments produced were divided into two. In group 1, fragments were demineralized and sterilized. In group 2, the fragments were not submitted to any additional treatment. The dentine fragments were then implanted in the muscle of mice. In group 3, the muscles were implanted with rehydrated lyophilized human bone powder. Animals were killed following test periods of 7, 15, 30, 60, 120 and 180 days, the fragments were removed together with adjacent muscle and examined under light microscopy to assess calcification. Results Areas of calcification were observed in groups 1 and 3 after a period of 180 days. In group 2, the surrounding tissues displayed only chronic inflammatory infiltration. Conclusions On the basis of the experimental model adopted in this study, fibroblast-rich connective tissue formed in groups 1 and 3, which could reflect an osteoinductive process. Further studies are suggested to identify which dentinal factors are capable of inducing the formation of a calcified matrix
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0 |
Dorsal approach to scaphoid nonunion
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Distal Radius Fractures
|
The surgical approach for treatment of scaphoid nonunion usually involves various combinations of screws and Kirschner wires, with or without bone grafts. This article reports our results with 36 dorsal-approach bone grafting procedures for treatment of scaphoid nonunion with Kirschner wires. Union was achieved in 89%. The average follow-up was 5 years. Flexion/extension averaged 76% of the opposite wrist, and grip strength was 88% of the opposite hand. Ninety-one percent of the employed patients returned to their original jobs. The dorsal approach provides satisfactory exposure for fragment reduction and bone grafting. [References: 29]
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0 |
Meniscal Allograft Transplantation After Anterior Cruciate Ligament Reconstruction Can Improve Knee Stability: A Comparison of Medial and Lateral Procedures
|
AMP (Acute Meniscal Pathology)
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BACKGROUND: The purpose of this study was to evaluate the clinical score and stability after meniscal allograft transplantation (MAT) after a previous anterior cruciate ligament (ACL) reconstruction.
HYPOTHESIS: Medial MAT would improve anteroposterior stability, and lateral MAT would improve rotational stability.
STUDY DESIGN: Cohort study; Level of evidence, 3.
METHOD: We retrospectively investigated 31 cases of MAT after a previous total or nearly total meniscectomy and ACL reconstruction between November 2008 and June 2017. Cases were divided into medial (16 cases) and lateral (15 cases) MAT groups. The patients were assessed preoperatively and at the 2-year follow-up.
RESULTS: In the medial MAT group, the International Knee Documentation Committee, Lysholm, Lysholm instability, and Tegner scores improved significantly at the 2-year follow-up, and there were also significant improvements in the anterior drawer, Lachman, and pivot-shift tests. In the lateral MAT group, the Lysholm and Tegner scores improved significantly at the 2-year follow-up, as had the anterior drawer and Lachman tests but not the pivot-shift test. The medial MAT group showed significant improvement in side-to-side difference on Telos stress radiographs, from 6.5 mm (preoperatively) to 3.6 mm (2-year follow-up) (P = .001), while the lateral MAT group showed no significant change. There was no progression of arthritis in either group.
CONCLUSION: Medial MAT improved not only anteroposterior stability but also rotational stability in the meniscus-deficient ACL-reconstructed knee. Lateral MAT showed improvements in the anterior drawer and Lachman tests but not in the pivot-shift test or side-to-side difference on Telos stress radiographs in meniscus-deficient ACL-reconstructed knees. Instability and pain are indications for MAT in meniscus-deficient ACL-reconstructed knees.
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0 |
The 'Gulf War syndrome'. Is there evidence of dysfunction in the nervous system?
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Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
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In a pilot study, 14 Gulf War veterans were randomly selected from a large list of those with unexplained illness, to compare the functional integrity of the peripheral and central nervous system with a group of 13 healthy civilian control subjects using predetermined outcome measures. The controls were matched closely for sex, handedness, and physical activity. Outcome measures included scoring of symptoms and clinical neurological signs, quantitative sensory testing of heat, cold and vibration sensibilities, motor and sensory nerve conduction studies on upper and lower limbs, needle EMG of distal and proximal muscles and multimodality evoked potential (visual, brainstem, and somatosensory) studies. Three measurements, all related to peripheral nerve function (cold threshold (P = 0.0002), sural nerve latency (P = 0.034), and median nerve sensory action potential (P = 0.030) were abnormal in the veterans compared with the controls. There may be a dysfunction in the veterans but more studies are required to investigate the findings further and to characterise the dysfunction if confirmed
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Clinical relevance and ethical aspects of placebos
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SR for PM on OA of All Extremities
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In recent years, the topic of placebo has gained momentum. Basic scientists started elucidating the neurophysiological and neuropharmacological processes that mediate the placebo response. At the same time, questions arose about the purported power of placebos. In addition, the debate on the ethics of the use of placebos heated up after the publication of some recent surgical trials using invasive placebo surgery procedures. In this article, we discuss the clinical relevance and the ethical problems associated with the use of placebos. Although a recent meta-analysis questioned the power of placebo, good evidence exists that placebos can lead to important improvement in many clinical conditions. A part of the conflict on the ethics of the use of placebos in randomized clinical trials can be solved by distinguishing between ethical guidelines for good clinical practice and for clinical research. We will also discuss some of the difficulties in finding proper placebo controls in clinical trials involving neurosurgical procedures. (copyright) 2005 Elsevier Inc. All rights reserved
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Expression of beta-defensin-4 in "an in vivo and ex vivo model" of human osteoarthritic knee meniscus
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AMP (Acute Meniscal Pathology)
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PURPOSE: To investigate, for the first time, the expression of beta-defensins-4, by immunohistochemistry and western blotting, in OA meniscus versus control meniscus, thus providing new insights into the physiological processes of meniscus repairing.
METHOD: beta-defensins-4 was studied in vivo, in knee osteoarthritic menisci obtained from 30 patients (20 men and 10 women) who underwent isolated arthroscopic partial medial or lateral meniscectomy, and in vitro on fibrochondrocyte cells from human OA knee menisci. The study was conducted using morphological, immunohistochemical, and Western blot analysis.
RESULTS: The histological results demonstrated structural alterations and cracks of OA menisci accompanied by a very strong beta-defensin-4 immunohistochemical staining. The Western blot analysis confirmed also a strong expression of beta-defensin-4 in OA fibrochondrocyte cells.
CONCLUSION: The present study suggests an activation of beta-defensin-4 induction, in human knee meniscus induced by the OA inflammatory process. It may represent an endogenous antibiotic defense mechanism accompanied by an intrinsic effort of tissue remodeling in OA articular joints. In conclusion, the present paper suggests the clinical relevance of beta-defensin-4 in the prospective of future alternative medical treatment for OA.
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Quality of life following proximal femoral replacement using a modular system in revision THA
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Management of Hip Fractures in the Elderly
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BACKGROUND: Proximal femoral replacement using a segmental modular system is one option for revision THA in the presence of severe bone loss or periprosthetic fracture. While many papers report function in these patients, they do not describe the quality of life. QUESTIONS/PURPOSES: We evaluated the quality of life in patients undergoing proximal femoral replacement using a segmental modular system for severe bone loss. PATIENTS AND METHODS: We retrospectively reviewed 63 patients undergoing complex revision THA using a modular replacement system for nonneoplastic conditions between April 1996 and June 2006. Average age was 73 years (range, 23-94 years). Twenty-one patients were lost to followup and six patients died before 2-year minimum followup. The remaining 36 patients were followed for an average of 3.2 years (range, 2-10 years). Study patients were matched by age-decade to a control group of patients undergoing conventional revision THA. At baseline, both groups were comparable with respect to age, comorbidities, and quality-of-life scores. RESULTS: At last followup, the modular system group showed improvement in WOMAC function, WOMAC pain, Oxford score, and the SF-12 mental component. Compared to the control group, the modular system group scored lower on WOMAC function and Oxford scores, but there were no differences in any other scores. CONCLUSIONS: In patients with severely compromised bone stock, a segmental modular replacement system can improve the quality of life. Special attention should be given to the stability of the hip intraoperatively and a constrained acetabular liner should be used when the risk of postoperative dislocation is high. LEVEL OF EVIDENCE: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence
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Hip fracture treatments--what happens to patients from residential care?
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Hip Fx in the Elderly 2019
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Hip fractures are a growing problem and new models of care have been called for. However, patients from residential care are rarely considered in these discussions. Hip fracture is a common serious problem for older people in residential care with profound effects on subsequent mobility and quality-of-life. There are no Australian data documenting differences in hospital treatments offered to patients from the community and residential care to inform discussions. In a prospective audit we describe the treatment and 4 month outcomes of patients with fractured hips who were admitted to Flinders Medical Centre in South Australia from the community and residential care between August 1998 and June 1999. Information was collected on prefracture health, types of surgical and rehabilitation treatments and dependency. Of the 215 older adults who were admitted during this time, 183 agreed to participate (119 from community and 64 from residential care). Surgical management of the fracture was not affected by admission accommodation. Those from residential care had short hospital stays, less rehabilitation and access to physiotherapy. Although 61% of those from residential care were classified as independently mobile prefracture, by 4 months this had declined to 32% of survivors. Strategies to improve outcomes in those from residential care include: early identification of those walking independently prefracture with assessment by rehabilitation teams. Inclusion of liaison with community therapists in the clinical pathway and in selected cases use of 'rehabilitation at home' services to provide physiotherapy services should be considered.
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